Thursday, June 25, 2015

Obamacare Lives

WASHINGTON — The Supreme Court ruled on Thursday that President Obama’s health care law may provide nationwide tax subsidies to help poor and middle-class people buy health insurance.
Chief Justice John G. Roberts Jr. wrote the majority opinion in the 6-to-3 decision. The court’s three most conservative members — Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — dissented.  From the New York Times.


  1. Undoubtedly, freedom will die because of this. An interesting side to this is that while conservatives will continue to bitch about Obama care, the bottom line is that the supremes have just taken this issue off the table for the next election. Republicans can continue to complain, but can now move away from pretending they will repeal it.

    Now that it's been upheld, hopefully they can fix it.

    1. Why fix something that is so successful?

    2. Zing! Be kind to your waiters and try the whipped tofu parfait. They need to fix it because we need to rethink the way care is delivered and manage costs better. Cutting provider salaries, which is going to happen, is not going to substantially lower the cost of medicine. The office I am doing my clinicals in has gotten very busy precisely because of Obama care.

      My preceptor, by nature of his personality, is VERY concerned about curtailing unnecessary costs. It's a shame that within my program, we did not have a class about this. instead of teaching us to practice with a Medical Home Model line of thinking, we instead wrote a bunch of bullshit papers comparing our system to systems around the world. Very time wasting.

    3. Why fix it? .... Cause it was designed to be fixed and was only a whistle-stop on the way to single payer.

      Now, having lived in the UK for almost ten years and having utilized a particular GP when I came here previously since 2000, I can say that having medical care free at the point of use is rather nice. I find myself in relatively good health so don’t need care that much. What I find quite disconcerting is that every single day on the news there is a story about a particular failing NHS trust, inadequate ambulance service, doctor shortages, nurse shortages, drugs not being available because of expense, extremely poor care for the elderly and always… always the complaint that the system doesn’t have enough money. What I see is a system of mediocre treatment that it crumbling under its own weight and it hasn’t even seen the costs of obesity and diabetes that are on the horizon… Of course you can buy private insurance, but if you are already paying the heavy taxes to afford the NHS, you will need to be relatively well off to get good medical care…. Kind of like public education vs private.
      All of the cost reductions, paperwork has been thrown back on GP’s. My GP retired early because of the way doctors were burdened with the cost functions of providing service… he said he could not be a good doctor and a bean counter as well and with the patience knowing full well that it would be him that would either authorize or deny service out of his budget, how could he possibly have a patients confidence.

    4. "how could he possibly have a patients confidence."

      maybe he could have their confidence if he kept them healthy?

    5. Spoken like a man with unlimited funds. In our world of “Dr. I saw this on the internet… I want some”, it is already difficult to manage the expectations of patients but when you place budget constraints directly on the doctor then patients will naturally wonder the motive for the denial of a test or a treatment particularly if the doctor actually has to prioritize treatments and make diagnostic choices that involve ‘wait and see’ because the funds need to be reserved for more acute situations. Besides... directly to your statement, sometimes no matter what resources you throw at someone’s health problem they just might get untreatably ill or even die.

      Think airplane crash when you only have a couple of ambulances… only with money constraints… The wells in none of these European utopias are unlimited and they are finding that out quite clearly in recent years. Frankly, the NHS is already spending a full 10% of its budget on diabetes related illness…. Wait until they start treating all of the fat, sedentary cradle to grave kids… End of life care may be provided sooner that one might expect…

    6. Tell me the constitutionally and philosophically acceptable solution TS. Sometimes the patients my preceptor sees do get pissed when he won't give them a test they want or when he won't bill medicare for something he thinks the patient should pay for. I get that these cradle to grave kids, (a phrase conservatives are intoxicated by for its fabulousness) are going to bankrupt the world and will eventually die and make heaven miserable too because they have been told that God loves them unconditionally, just like their parents and their Robin Hood governments.

      How do you instill the personal responsibility that conservatives believe will save everything? I don't say this next to be dramatic, but unless you are willing to simply let people die who can't afford health insurance, you aren't going to get personal responsibility. It's interesting you mention that example of the internet because to me, that represents the dominant influence of treating healthcare like just another commodity to consume. whether a government coddles people or not, I tend to believe that anyone who spends any time in our modern world versus some despot country will by default begin to think they deserve some minimum standard of living. How do you cope with this? Raise children in a shed with no modern gadgets at all? Tell them to their face everyday they deserve nothing?

      Again, I get it. EVERY government program will grow like an obese spoiled child until it consumes every last speck of wealth ever created. With that in mind, what is the solution?

    7. The left like paint anyone who does not agree with their version of a solution as not only wrong but labelled as a hater, heartless, racist… you know the list. Actually people from a broad spectrum of society want to see the healthcare problem solved as only a truly heartless person has no compassion for people who are ill, homeless or poor because of circumstances beyond their control or ability. The ‘solution’ is actually addressing the facts as they are and the historical missteps that created them. The left appear to be similarly disposed to the mental efforts required to address the causes as they are the potential consequences. OPM is the solution to everything.

      I have continually made two points about the solution to the healthcare problems.

      The first looking backwards at history and the governmental policies that shaped the problem we have today; The second, looking forward to the consequences of the kinds of solutions that have been implemented in other programs and where human nature (and bleeding hearts) will inevitably take us.

      The first of course is how we got insurance as part of our medical delivery system in the first place? Who opened that can of worms and why? From there is a stack of government regulation and manipulations that have distorted every aspect of medicine today… can you name any and how removing or rewriting them might help the situation?

      The second is what happens when you place ‘healthcare’ as a right and stand it next to things like the right to breathe. The left, obsessed with the belief the OMP can fix any ailment an affluent society might have, never takes into account human nature and the effects of their actions on it. We don’t want to talk about the fact that healthcare as a right is open ended, ultimately undeliverable, damaging to the development of medical understanding and harmful to the concept of a free people.

      I would have had some respect for the process IF those who hold healthcare as a right would have put limits… any limits … on what is considered healthcare.

      What is too expensive? At what point do we say that the cost is too great to save a particular individuals life… or quality of life be they 10 or 80. Those decisions will be made and it will be done by committee regardless the name you attach to it. By refusing to acknowledge the term ‘death panel’ you refuse to acknowledge the very real limitations to healthcare as a ‘right’).

      What demands a certain amount of personal responsibility and their fore personal financial hardship? Should we save the life of a motorcyclist that refuses to wear a helmet, yes… should he/she have to pay a handy price up to and including bankruptcy for the indiscretion?

      Where does our quest to reverse nature’s shortcomings in an otherwise healthy individual end? Expensive fertility treatments, egg and sperm storage, ever more elaborate treatments while, at the same time we are also paying to kill ‘unwanted’ children… how about a natural disfigurement or a big nose that ‘harms’ a person’s quality of life…. Or their physiological wellbeing? And of course our ‘responsibility’ to insure that a woman can be as sexually active as she chooses without inhibiting her other life choices courtesy of others who people who pay for it.

      This slippery slope also leads us down the path of ever tighter social control… what you can do, what you cannot, what you will eat and what you won’t, what is deemed harmful to mental health and what isn’t… because each and every one of these life choices become the cost and responsibility of someone else... and that is a shift of responsibility that is extremely harmful to a productive society.

    8. Can't say much now as I am about the head out the door for clinical. However, this may surprise you TS, but I do not believe healthcare is a right. Second, I do believe there needs to be limits on how much health care a person can consume as part of insurance. As an ICU nurse and now hospice nurse, I can give as many examples as you want to hear about how much waste I have seen. The death panel term is bullshit and is meant to scare people. I think there should be a baseline plan for everyone, and if people want something above that, then let the private insurance market deal with that.

      I don't believe, as you might assume, in full government control of healthcare. That said, private insurance is nothing more than cherry picking of relatively healthier people while leaving me as a tax payer on the hook for the uninsured and the comparatively sicker patients. Insurance is a risk pool, and I feel we would be far better served by a basic plan that allows for people to personally pay for as much private insurance as they want.

      As for you being heartless, read what you want into my comments. I don't believe conservatives are heartless. That said, their persistence to perpetually look backwards and say Y problem today is because of X government intervetion and therefore we need to pound that Fn nail over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and over and so on. Regardless of what bad decisions have been made in the past, the problem exists TODAY. the problems that exist in today's world are the ones I want to solve.

  2. I agree. This was a tremendous favor to the republicans, as they can't be held responsible for the millions who would have lost their health insurance.

    1. Those people don't vote Republican Mick.

    2. Are you saying that only people who vote Democrat got insurance? Are you really making that ridiculous claim? Are you really that clueless? Republicans have feared, correctly so, that many of their constituents would get insurance and demand it be kept.

  3. I am saying Max that most people without insurance were lower income. Most lower income people vote Democrat when the do vote.

    1. I cut my political teeth during the Nixon administration when the currency was debased. The debasing of the meaning of words by SCOTUS and our political apparatus is a logical extension.

      Good luck Max at working within what will increasingly become an Orwell ian healthcare situation. HRC will be the perfect custodian of this national nightmare.

      1773-2009 Underground Freedom Fighter

    2. She's great at parsing and lieing. You might give her a second look.

  4. TS, I read that health insurance was invented by Baylor University during the depression. Their fine hospital was a collection of mostly empty beds because people couldn't afford medical care. They offered a plan whereby people could pay them a monthly fee, I believe it was 50 cents, and they would be guaranteed paid medical care. This proved very popular and eventually morphed into the Blue Cross system.

    1. You will have also noted that the developers of these early plans were the hospitals themselves, generally to support their own staff and educational institutions the were attached to and operated strictly as non-profit mechanisms to allow their patents to pay their medical bills. That is the fees collected were no more than the cost of service. Almost all plans at the time were major medical and were given non-profit status. Blue Cross itself didn’t become an actual company until 1960.

      While insurance has existed since the 1850s as ‘accidental’ coverage the injection of insurance into the workplace was as a direct result of government wage controls in the 1940’s and a bit of activist support for unions by adding insurance as a form of wage in the 1950’s. Were it not for the wage controls business would still be negotiating strictly in wages and without the widespread use of insurance as a union wage tactic we wouldn’t have insurance being used to pay doctors for a runny nose….

    2. " Were it not for the wage controls business would still be negotiating strictly in wages and without the widespread use of insurance as a union wage tactic we wouldn’t have insurance being used to pay doctors for a runny nose…."

      And if Eve ignored the snake, we would all still be living in the Garden of Eden.

    3. Insurance morphed from pre-pay plans into it's current big business status when the companies began the use of statistics, through professional actuaries. As long as the statistics are valid, the company is guaranteed of a profit. The magic of mathematics.

    4. Mick... that still says nothing as to why it became the absolute middleman in the delivery of healthcare... The answer for that lies at the feet of government interference where it had no business. The war effort would have continued full steam ahead because of a pride filled nation and wages would have taken care of themselves. Those statistical outcomes were in play with accidental death insurance long before… it wasn’t a new invention just the acknowledgement of the existence of a lot of information provided by mountains of private medical research and the results attributed to them.

      Mike... so… who is the snake … and why do we keep biting the apple and expect a different result.

    5. My comment was really just a snark that this perpetual need to look backward in order to cherry pick information to create a context is a bit silly. I'm not being a wise as here TS, but i really respect your knowledge of history and even your scholarship of the constitution. Yet, I read your posts and come to the same frustrating conclusions that I did when I read Rand, Hayek and some others in the conservative world. I just don't believe it's thats simple, and the context that is drawn nearly always leaves out what conservatives don't want to discuss, which is the confounding aspect of human nature. Put another way, you make masterful arguments to make your points, and as long as we stay rigidly on point and don't ask questions, the premises you reach are well supported.

      A premise that many conservatives float, whether stated directly or not, is that all slacking, cheating and desire to seek comfort without working hard has a governmental cause as it's fountainhead. Here, the premise is that because of government interference, unions were allowed to create widespread of insurance, and subsequently, people now use insurance for a runny nose. No mention there of individual responsibility. My wife an I don't run to the doctor every time we get a cold, and millions of other people don't either. And as you know, I am a communist. The bottom line for me is that no matter what station in life a person resides, they will seek to have as much comfort and happiness as possible for as little effort expended. Pretty much like how the free market works, only exchange profit for comfort.

      People are bombarded every day with messages on TV to try this or that drug and subconsciously, they are bombarded with a message that if they feel bad from time to time, they deserve to feel better and there is a pill or treatment for that. IMO, the principle of making a buck is just as causative here as any historical+governmental influence = every thing bad arguments you can come up with. I don't deny your arguments have merit, because I think they do. but, they are far from airtight and are selectively void of the introduction of any thinking that is "gray" in nature.

      I believe insurance companies are like any other business. They grew, developed a market plan, and used their growing size to protect their interests. We can, of course, cleverly say, "Well, none of this would exist today if the government didn't intervene in 1850". It's moot to me and it's sort of like some arguments people used to make on Market Watch wherein it was suggested that the credit reinvestment act of 1970 caused the housing fiasco in 2008 because the CRA forced banks to actually invest in the communities they made money on. Real life is sloppy and no amount of rules is going to change that, which is message lost of farther left and farther right types.

    6. You give my imagination way to much credit Mike. While it may seem like cherry picking to you the foul ability of government provides rich pickings for anyone who wants to connect the dots. My wife once looked over my shoulder while I was reading something on here that appeared to be quite removed from the topic of ‘American Politics’ and was puzzled as to why it was even being discussed. I told her why and just what the link was. The fact is, relatively few of our actions are devoid of government oversight or outright control.

      The government is full of contradiction and conflict of interest. How can a government that supposedly speaks of equal justice under the law be allowed to operate when it (and its career politician apparatus) clearly has a vested interest in so many outcomes… is the government ‘of the people’ supposed to have any ‘vested interests’ other than the security of the population?

      I look to the constitution because it IS (or at least is supposed to be) the basic law from which all other law is created. Without a firm set of rules it is difficult to understand the game. It comes with a set of instructions as to how to change it, yet because interested parties can’t quite muster the numbers required, the LAW is ignored for something that will undoubtedly cause conflict in the future.
      I look to the past because it is the only place we can learn from. I don’t live in the past and know, as the stock advisory disclaimer states: Past performance in no indication of future profits. Of course the problems of today are not identical, but to disregard the failures of the past and the reasons for them is to invite the same mistakes again. Have you ever sat down and studied many of the really hideous Supreme Court decisions and the laws that they supported? That alone should scare you back into the arms of the constitution.

      With respect to what we are talking about, I don’t know how many times wage and price controls have been implemented by government only to created serious long term consequences… sense when did government have a right to dictate GDP?… we didn’t institute the government to be the chairman of the board… and if we did, I think it is high time we tell them…. YOU’RE FIRED!

      What I keep saying over and over again with example after example is that our deviation from the constitution and our willingness to turn over our personal responsibility and by default, liberty to the government; particularly the federal government has done us little favor, when, in all likelihood, had the problem been left either with society at large or with REAL free market interaction, things would have turned as they should.

      I realize as did Ron Paul that while most government agencies are at best less than useful and at worst harmful to a productive society, you cannot just eliminated them over night…. But you can damn well curtail their operations so that they do less harm. The hard part isn’t taking the power away from government the truly hard bit is getting people to step up and accept responsibility for their own life and future.

      As far as conservatives thinking that is that all slacking, cheating and desire to seek comfort without working hard has a governmental cause as it's fountainhead, if you think about it, liberals do too… they are just too tied to the idea of government solution to connect the dots… which is why I say that Occupy Wall Street, though rather mixed in their message, was on point…. They were just pointing in the wrong direction. And yes, there are areas of grey… there will always be some sort of problem that needs addressing but it is impossible when you have the great… well-funded enabler sitting right in the middle of everything.

    7. "The government is full of contradiction and conflict of interest."

      This, to me, sums up the entirety of life. This is not a refutation of your post TS, but it's not love of central planning and desire to have someone take responsibility for my life that drives my thinking. I can connect the dots as well as you, and for a long time I did, and that works great, like I said, as long as we limit the variables. People at times will do the stupidest shit, only to turn right around and do something that floors you for it's genius. My frustration with the constitution will always be that, in the words of Scalia, it is a dead document.

    8. Don't go their Mike.... context is everything and you either just validated everything I have said or you are twisting the meaning of his words much like central government types have done to the constitution for decades.

    9. Admittedly, I have validated your point, or at the least, I can't refute it in a context you agree with. I'm genuinely not a big government type, and I'm not in favor of trying to fix everything with a social program. On some level, I think that my frustrations are really not that different from what conservatives are frustrated about. What is different though, is indeed context. I can't refute much of what you say because I don't share your context of viewing the entire world through constitutionally colored glasses. Conservatives acknowledge there is gray in the world, but I tend to think most of them believe there would be a lot less of it if people simply followed the rules. Liberals like myself acknowledge that personal responsibility IS a big issue, but also maintain a context that while rules are great, a vast majority of people typically get ahead because they judiciously break them.

      I've made the point before that in the situation of the housing blowup, the market didn't need to create ninja loans, and the big banks didn't have to package all these bullshit loans into securities that they duped rating agencies into slapping a AAA rating on. By the same token, the not so bright people who took these loans also didn't need to convince themselves they could buy a 500k house though they only made 50k a year. I believe regulation can and DID prevent this from happening in the past. To me, this one scenario presents the context that I view the world in, which is that no matter what the rules are, people will find a way to skirt them to get themselves ahead without giving a damn about how it will affect others. Which brings my to the dead document point.

      Nothing stays the same forever. the thinking of the day that created the constitution was brilliant, though clearly not inclusive of people who weren't white men. Social thinking moved on that and eventually, the document was amended to correct some glaring mistakes. There is a process for doing this the right way that thankfully is very difficult to accomplish. Still, my personal opinion is that I have frequently seen times where I felt a majority opinion existed that could not be expressed in legislation because of a gridlocked, gerrymandered government. Further, I don't believe we should continually amend the constitution. I believe we could accomplish our needs without doing so. Therein, however, lies the rub. I don't think I'm twisting Scalia's words. In his mind, which is very religious and conservative, every answer we could possibly need was decided a long time ago and therefore, we should just concede that and stop trying to skirt the constitution in order to address whatever we feel is a social problem. Recapping, I see your point, and you are correct. You will always have a winning argument against my posts because I believe that at the end of the day, your view is concrete, the constitution allows something, or it doesn't. If it doesn't allow for something, it's really not worth discussing because discussing it will only allow for emotion to get involved which leads to creating bad laws that aren't constitutional.

    10. You are right Mike, things do change. The meaning of ‘Men’ , as in ‘all men are created equal’ has changed in the context of who is covered under the umbrella of the constitution. As society changed and the definition of men broadened so did the meaning of men. Of course an amendment was needed to strike the effects of the 3/5th compromise but amendments like the ERA pushed by NOW is redundant and unnecessary. What is needed and what has been very lacking by government is actually treating ‘all men’ equal.

      If we wanted, for instance, to change the depth and breadth of ‘freedom of the press’ which is quite broad and definitive in its nature… is a specific amendment restating that provision’s boundaries. If you don’t have enough votes to change the constitution then you don’t have the right to create laws to circumvent it.

      The deal is… you ether believe in the rule of law… or you believe in the rule of man. There is no fuzzy line between the two and the more legislatures and lawyers blur that line, the more you always move in the direction of the rule of man. I don’t recall a nation in history run by the rule of man that ever worked out in favour of the common man. That goes for the populous knee jerks of direct democracies as well…

      We of course will agree to disagree and the world will carry on… I just wouldn’t wish to be one of my grandchildren… I think that reincarnation into our near (200 years) would be 1) hell on earth and 2) a death sentence for anyone not of the aristocracy and their chosen friends.

      P.S. Emotion is exactly what the agreement to rule of law was meant to keep in check