Healthcare Content (Protest Instructions) >>>>>

[Poster Nutbag]

Here's a slide show of what is basically included in the reform bill...

http://www.salon.com/news/feature/2010/03/19/healthcare_facts_slideshow/slideshow.html#

[phuzzyfish12]

(click to enlarge)

we could have had a good bill if the top minds in both parties sat down and discussed it with input from the medical community, and didn't worry about the politics. Being that this is the USA in the 21 century, an intelligent process in lawmaking is impossible, and this is what we got stuck with.

due to the way the government in your country is set up, a two party system that requires unwavering polarity for its populous support, this is how you must now advance legislation. First, get the ball rolling no matter how bad it looks on paper, as has just happened. And then, when the dust settles, both sides will come to the table, having dropped their polemical arguments so that they may hammer out something that will truly help the country. This is the only way that the legislative process can be steered away from a zero sum game and in this manner neither loses face (Japanese term not to be confused with melting face).

+K to RJ and Superfreakie

[mbw]

[guyforget]

the bill's going back to the house

[tet]

anything you say in vwashington somebodys gonna bitch at you per se. so, end of the day, millions of people are now insured. in the words of a raggae tune, "if love were a king that money woulda buyed, the rich woulda lived, the poor woulda DIED"

probably the most cogent thing you've uttered yet on the paug... 

[sls.stormyrider]

the bill's going back to the house

not "the BILL", the reconciliation.

[guyforget]

correct, the reconciliation bill

it was late... 

[sls.stormyrider]

[mbw]

Republicans, Leukemia Team Up To Repeal Health Care Law
April 8, 2010 | ISSUE 46•14

Key Republicans and the blood cancer leukemia make a joint statement condemning the health care bill.

WASHINGTON—Citing a mutually shared vision of health care in America, congressional Republicans and the deadly bone-marrow cancer leukemia announced a joint effort Wednesday to repeal the Patient Protection and Affordable Care Act, the historic new bill that extends health benefits to 32 million Americans nationwide.

"Republicans have no greater ally in this fight than leukemia," said Sen. Jim DeMint (R-SC), who was flanked by Sen. Mitch McConnell (R-KY), House Minority Leader John Boehner (R-OH), and the abnormal increase in white blood cells. "Denying insurance to Americans with preexisting conditions and ensuring that low-income Americans stand no chance of receiving quality health care are just a few of the core beliefs that the GOP and leukemia share."

"And believe me, if anyone is angrier than the Republican Party that children can no longer be denied coverage for having preexisting conditions, it's leukemia." DeMint continued. "We're a match made in heaven."

continued @ http://www.theonion.com/articles/republicans-leukemia-team-up-to-repeal-health-care,17215/

[guyforget]

[sls.stormyrider]

thought this was a good time to bump this one.
on the way to the Supreme Court

Appeals court strikes health insurance requirement

By Greg Bluestein
Associated Press / August 12, 2011
ATLANTA—A federal appeals panel struck down the centerpiece of President Barack Obama's sweeping health care overhaul Friday, moving the argument over whether Americans can be required to buy health insurance a step closer to the U.S. Supreme Court.


Tweet 3 people Tweeted this
ShareThis
The divided three-judge panel of the 11th Circuit Court of Appeals concluded Congress overstepped its authority when lawmakers passed the so-called individual mandate, the first such decision by a federal appeals court. It's a stinging blow to Obama's signature legislative achievement, as most experts agree the requirement that Americans carry health insurance -- or face tax penalties -- is the foundation for other parts of the law.

Chief Judge Joel Dubina and Circuit Judge Frank Hull found in a 207-page opinion that lawmakers cannot require residents to "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."

In a lengthy dissent, Circuit Judge Stanley Marcus accused the majority of ignoring the "undeniable fact that Congress' commerce power has grown exponentially over the past two centuries." He wrote that Congress generally has the constitutional authority to create rules regulating large areas of the national economy.

The White House argued the legislative branch was using a "quintessential" power -- its constitutional ability to regulate interstate commerce, including the health care industry -- when it passed the overhaul law. Administration officials said they are confident the ruling will not stand. The Justice Department can ask the full 11th Circuit to review the panel's ruling and will also likely appeal to the Supreme Court.

"Individuals who choose to go without health insurance are making an economic decision that affects all of us -- when people without insurance obtain health care they cannot pay for, those with insurance and taxpayers are often left to pick up the tab," said White House adviser Stephanie Cutter.

The 11th Circuit's ruling, which sided with 26 states that had sued to stop the law from taking effect, is the latest contradictory judicial opinion on the health care debate. The federal appeals court in Cincinnati upheld the individual mandate in June, and an appeals court in Richmond has heard similar challenges to the law. Several lower court judges have also issued differing opinions on the debate.

Legal observers long expected the case would ultimately land in the Supreme Court, but experts said Friday's ruling could finally force the justices to take the case.

"There needs to be a pronouncement that's nationwide," said Carl Tobias, a professor at the University of Richmond School of Law. "It would be almost impossible to implement it if we have splintered decisions from different geographic circuits. The Supreme Court may feel now it has to take it."

J. Peter Rich, a Los Angeles-based health care attorney, said the Supreme Court had never weighed in on an issue such as the provision requiring individuals to buy health insurance.

"They have never ruled on this specific issue," he said. "This really is a case of first impression, although the Obama administration may try to argue otherwise."

Rich said it's not unconstitutional for individual states to have such requirements, noting that Massachusetts has a similar law in place. However, the high court has yet to weigh in on whether a federal requirement passes muster.

It's the latest hit the president's taken in what's been a rough month that's included humiliating blows on both the economy and in Afghanistan, while polls show deteriorating public support for both him and Congress.

Obama has been criticized by his Democratic base for his failures, which include dropping his push for tax increases as part of last week's compromise to raise the government's debt ceiling and his inability to let the Bush tax cuts for the wealthy to expire at the end of last year.

The Atlanta-based court is considered by many observers to be the most pivotal legal battleground yet because it reviewed a sweeping ruling by U.S. District Judge Roger Vinson, who not only struck down the individual mandate but threw out other provisions ranging from Medicare discounts for some seniors to a change that allows adult children up to age 26 to remain on their parents' coverage.

His reasoning was that the insurance requirement was "inextricably bound together" with the rest of the law, but the 11th Circuit concluded Vinson went too far. The panel's ruling noted that the "lion's share of the act has nothing to do with private insurance, much less the mandate that individuals buy insurance."

The provision requiring all Americans to carry health insurance or face a tax penalty has been at the center of the legal debate. The law does not allow insurers to turn away the sick or charge them outrageous premiums. To cover their health care costs, others -- particularly the young and healthy -- will need to pay premiums to keep costs from skyrocketing. The potential tax penalties are meant to ensure they will do so.

The Obama Administration also has a little-known fallback if it loses the court battle. The government can borrow a strategy that Medicare uses to compel consumers to sign up for insurance.

Medicare's "Part B" coverage for doctor visits carries its own monthly premium. Yet more than nine in 10 seniors sign up. The reason: Those who opt out when they first become eligible face a lifelong tax penalty that escalates the longer they wait.

The key difference is that the Medicare law doesn't require that seniors buy the Part B coverage. Experts say Obama's overhaul could also be changed in a similar fashion.

The states had urged the 11th Circuit to uphold Vinson's ruling, saying in a court filing that letting the law stand would set a troubling precedent that "would imperil individual liberty, render Congress's other enumerated powers superfluous, and allow Congress to usurp the general police power reserved to the states."

The Justice Department countered that Congress had the power to require most people to buy health insurance or face tax penalties because Congress can regulate businesses that operate across state lines, including health care providers.

The reaction was swift and celebratory from the states that filed the lawsuit.

Michigan Attorney General Bill Schuette called the decision a "huge victory in the fight to protect the freedom of American citizens from the long arm of the federal government." Alabama Attorney General Luther Strange called it a "monumental case" for individual liberty. And Texas Attorney General Greg Abbott declared: "'Obamacare' is closer to an end."

A separate legal ruling Friday also buoyed critics of the law. The Ohio Supreme Court appeared to clear the way for voters there to decide whether to reject parts of the health care law in November with a unanimous ruling that rejected a liberal policy group's challenge of the so-called Health Care Freedom Amendment.

But the administration did get a small dose of good news Friday. The federal appeals court in San Francisco found that a former California lawmaker and a legal foundation could not file another challenge on the overhaul.

The 11th Circuit's ruling in Atlanta didn't come as a complete surprise. During oral arguments in June, each of the three judges repeatedly raised questions about the overhaul and expressed unease with the insurance requirement. And each judge worried aloud if upholding the landmark law could open the door to Congress adopting other sweeping economic mandates.

The arguments took place in what's considered one of the nation's most conservative appeals courts, but the randomly selected panel represents different judicial perspectives.

None of the three is considered either a stalwart conservative or an unfaltering liberal, but observers were quick to point out that the decisive vote came from a Democrat appointee. Hull, a former federal judge in Atlanta, was tapped by President Bill Clinton.

[runawayjimbo]

http://www.realclearpolitics.com/articles/2011/10/21/obamacares_broken_promises_111762.html

ObamaCare's Broken Promises

WASHINGTON -- Hard times continue for the Affordable Care Act (aka Obamacare). The administration has scrapped the law's long-term care insurance program, covering nursing homes and home health care. The program was deemed unrealistic. This is a harbinger. As the law is implemented -- assuming the Supreme Court doesn't declare it unconstitutional or Republicans don't repeal it -- disappointments will mount.

Nursing homes are expensive; typical costs can run up to $80,000 per patient annually. Home health care averages almost $22,000. The ACA mandated that the long-term insurance, called CLASS (for Community Living Assistance Services and Supports), be self-sustaining. Private insurance premiums would cover costs without government subsidies. Impossible, the administration found.

Premiums would be high, at least $235 and a month and perhaps as much as $3,000. People wouldn't sign up, and those who did would be very sick. Huge deficits would eventually emerge. Maybe CLASS supporters cynically hoped the administration would justify artificially low premiums. Government would then have to cover the ultimate shortfalls or throw thousands of elderly into the streets. The administration wisely rejected that path.

This setback heralds others. Controlling health spending was a major promise. After all, it's called the Affordable Care Act, and boosters argue that it will subdue runaway spending. It almost certainly won't. One prominent skeptic is Arnold Relman, the former editor of The New England Journal of Medicine.

Writing in The New York Review of Books, Relman says that "the law does very little or nothing to address some of the most important causes of the high cost of care and its rapid inflation." Note: Relman isn't a conservative crank. He's a critic of insurance companies and advocates a single-payer, government-run health-care system.

The ACA, Relman writes, doesn't alter fee-for-service reimbursement that gives "all physicians strong financial incentives to provide more services than needed." The resulting "fragmentation of medical care ... allows specialists to practice in isolation without restraints on cost, causes duplication and disorganization of services, and discourages the use of primary care physicians."

Relman is unimpressed with the ACA provisions intended to control costs: for example, the Independent Payment Advisory Board (IPAB). It's a group of 15 experts who would recommend changes if government health spending rose too rapidly.

"However, the law stipulates that the IPAB cannot reduce Medicare benefits or increase Medicare premiums, and it defers any proposed reductions in payments to hospitals for a few years," Relman writes. The IPAB would mainly cut physicians' Medicare reimbursement rates, he says. But doctors could "easily" offset these cuts "by providing more services, such as performing more diagnostic tests."

Relman also dismisses "accountable care organizations" (ACOs) that supposedly save money through coordinated care by doctors and hospitals. The regulations governing ACOs will be so complicated that there won't be many of them, he writes.

"Restructuring the delivery of medical care" is essential, Relman says. He takes hope in the growth of multi-specialty groups that include both primary doctors and specialists. Nearly 200,000 doctors, about a quarter of practicing physicians, now belong to these groups, he says. On paper, they can better control costs by limiting duplication, fostering cooperation and eliminating wasteful services. But this isn't likely as long as fee-for-service prevails.

Something needs to force change. Republicans have a strategy. Rep. Paul Ryan would convert Medicare -- the nation's largest insurance program -- into a voucher system. Medicare beneficiaries would receive a fixed amount and would shop for the most appealing health plan that their money would buy. Government spending would be limited by size of the vouchers. To attract patients, doctors and hospitals would be compelled -- so the theory goes -- to combine in ways that lowered costs and improved quality. Through tax credits, the same approach would apply to the under-65 population.

Relman's solution is not entirely dissimilar. He would replace fee-for-service with an annual per-patient payment to doctors who would be responsible for the patient's "comprehensive care." Both Ryan's voucher and Relman's lump sum are what health experts call "capitation" or "global payments." The big difference is that Relman would have government administer the payments directly, with attendant regulations. A single-payer system, he thinks, would extract savings from the overhead and profit of the insurance industry. In 2011, that's estimated at $152 billion, 5.6 percent of health spending.

Despite profound differences, both these radical proposals proceed from common premises: Limiting health-care spending requires explicit ceilings on the dollars put into the system; and changing incentives for doctors and hospitals will create a superior delivery system. We should be debating ideas like these, because overhauling the health-care system is important in its own right and for controlling federal spending. Instead, the ACA skews the agenda. Many of its promises rest, like CLASS, on unrealistic assumptions. Disappointments loom, and the needed debate is deferred.

[sls.stormyrider]

Appeals court upholds Obama health care law
By Nedra Pickler
Associated Press / November 8, 2011

WASHINGTON—A conservative-leaning appeals court panel on Tuesday upheld the constitutionality of President Barack Obama's health care law, as the Supreme Court prepares to consider this week whether to resolve conflicting rulings over the law's requirement that all Americans buy health care insurance.

A panel of the U.S. Court of Appeals for the District of Columbia issued a split opinion upholding the lower court's ruling that found Congress did not overstep its authority in requiring people to have insurance or pay a penalty on their taxes, beginning in 2014. The requirement is the most controversial requirement of Obama's signature domestic legislative achievement and the focus of conflicting opinions from judges across the country. The Supreme Court could decide as early as Thursday during a closed meeting of the justices whether to accept appeals from some of those earlier rulings.

The suit in Washington was brought by the American Center for Law and Justice, a legal group founded by evangelist Pat Robertson. It claimed that the insurance mandate is unconstitutional because it forces Americans to buy a product for the rest of their lives and that it violates the religious freedom of those who choose not to have insurance because they rely on God to protect them from harm. But the court ruled that Congress had the power to pass the requirement to ensure that all Americans can have health care coverage, even if it infringes on individual liberty.

"That a direct requirement for most Americans to purchase any product or service seems an intrusive exercise of legislative power surely explains why Congress has not used this authority before -- but that seems to us a political judgment rather than a recognition of constitutional limitations," Judge Laurence Silberman, an appointee of President Ronald Reagan wrote in the court's opinion. Silberman was joined by Judge Harry Edwards, a Carter appointee. But, they added, "The right to be free from federal regulation is not absolute and yields to the imperative that Congress be free to forge national solutions to national problems."

Judge Brett Kavanaugh, a former aide to President George W. Bush who appointed him to the bench, disagreed with the conclusion without taking a position on the merits of the law. He wrote a lengthy opinion arguing the court doesn't have jurisdiction to review the health care mandate until after it takes effect in 2014.

The federal appeals court in Cincinnati also upheld the law. The federal appeals court in Atlanta struck down the core requirement that Americans buy health insurance or pay a penalty, while upholding the rest of the law.

And like Kavanaugh's dissenting opinion, an appeals court in Richmond, Va., ruled it was premature to decide the law's constitutionality. This aspect of the court challenges issue involves a federal law aimed at preventing lawsuits from tying up tax collection. Kavanaugh and the Richmond court held that taxpayers must begin paying the penalty for not purchasing insurance before they can challenge it in court.

Jay Sekulow, chief counsel for the American Center for Law and Justice, which filed the suit in Washington, said the group is considering whether to ask the full appeals court to hear the case or make a request directly to the Supreme Court. "We still remain confident that Obamacare and the individual mandate, which forces Americans to purchase health insurance, is the wrong prescription for America and ultimately will be struck down as unconstitutional by the U.S. Supreme Court," Sekulow said.

The liberal interest group Constitutional Accountability Center said the ruling from a solid conservative like Silberman, as the Supreme Court prepares to take up the issue, is a "devastating blow" to opponents of the law.

"With two prominent conservatives, this panel was thought to be a dream come true for conservative challengers of the act," said the center's president, Doug Kendall. "Today that dream became a nightmare, as the panel unanimously rejected the challenges to the act, disagreeing only about why those challenges failed."

[sls.stormyrider]

didn't see your post until just now.
One of the valid criticisms of the ACA is that it does nothing directly to reduce costs. Indirectly, by encouraging cooperation among providers (ACOs, I think they are called), electronic health records (which will hopefully reduce duplication and errors) and other initiatives they are hoping costs will go down. Also, by making health care accessible, people can get into the system for preventative care or care in the early stage of disease as opposed to just going to ERs (expensive) or waiting until they are sick (also expensive).

Capitation was tried in the northeast in the mid to late 90s and was eventually discarded by the insurance companies. They didn't publicly state why - either it wasn't saving as much $ as they thought or there were pt complaints who felt their doctor's interests were to NOT give care, order tests, etc, as opposed to giving care.

I don't claim to know the real answer - if there was one someone would have come up with it by now

[runawayjimbo]

Drumroll, please. A SCOTUS decision in the middle of the campaign should make for some entertaining debates.

http://www.nytimes.com/2011/11/15/us/supreme-court-to-hear-case-challenging-health-law.html

Supreme Court to Hear Case Challenging Health Law

WASHINGTON — The Supreme Court on Monday agreed to hear a challenge to the 2010 health care overhaul law, President Obama's signature legislative achievement. The development set the stage for oral arguments by March and a decision in late June, in the midst of the 2012 presidential campaign.

The court's decision to step in had been expected, but Monday's order answered many questions about just how the case would proceed. Indeed, it offered a roadmap toward a ruling that will help define the legacy of the Supreme Court under Chief Justice John G. Roberts Jr.

Appeals from three courts had been vying for the justices' attention, presenting an array of issues beyond the central one of whether Congress has the constitutional power to require people to purchase health insurance or face a penalty through the so-called individual mandate.

The Supreme Court agreed to hear appeals from just one decision, from the United States Court of Appeals for the 11th Circuit, in Atlanta, the only one so far striking down the mandate. The decision, from a divided three-judge panel, said the mandate overstepped Congressional authority and could not be justified by the constitutional power "to regulate commerce" or "to lay and collect taxes."

The appeals court went no further, though, severing the mandate from the rest of the law.

On Monday, the justices agreed to decide not only whether the mandate is constitutional but also whether, if it is not, how much of the balance of the law, the Patient Protection and Affordable Care Act, must fall along with it.

Even the Obama administration, while arguing that the mandate is perfectly constitutional, has said that it is "absolutely intertwined" with two other provisions — one forbidding insurers to turn away applicants, the other barring them from taking account of pre-existing conditions.

The 11th Circuit ruled for the administration on another point, rejecting a challenge to the law's expansion of the Medicaid program. The Supreme Court also agreed to hear an appeal from that ruling.

The 26 states, represented by Paul D. Clement, a former United States solicitor general, had argued that Congress had exceeded its constitutional authority by expanding the eligibility and coverage thresholds that states must adopt to remain eligible to participate in Medicaid.

The problem, Mr. Clement wrote, was that "Congress did not tie its new conditions only to those additional federal funds made newly available under" the Affordable Care Act. "It instead made the new terms a condition of continued participation in Medicaid, thereby threatening each State with the loss of all federal Medicaid funds — on average, more than a billion dollars per year — unless it adopts the act's substantial expansions of state obligations."

On Monday, the justices agreed to consider that question. The justices also said they would consider an intriguing threshold issue.

In September, a divided three-judge panel of the United States Court of Appeals for the Fourth Circuit, in Richmond, Va., ruled that it was premature to decide the case in light of the Anti-Injunction Act, a federal law that bars suits "for the purpose of restraining the assessment or collection of any tax." The Supreme Court had interpreted the term "tax" very broadly for purposes of the law.

If the Fourth Circuit ruling is correct, individuals may not challenge the individual mandate until the first penalty is due in April 2015. On Tuesday, a dissenting judge on the United States Court of Appeals for the District of Columbia Circuit also endorsed that position.

The administration had initially pressed but later abandoned the argument. In the Supreme Court, the Justice Department suggested that the court consider the issue and perhaps appoint a lawyer to present arguments in favor of it, as the court occasionally does when the parties agree on a significant issue that could alter the outcome of the eventual decision.