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[sls.stormyrider]

Of course insurance premimums were already going up exponentially before Obamacare and the laws haven't fully taken effect yet.

exactly.
health care expenses have been rising faster than the GNP since the 70s. The increases we are seeing now is a byproduct of health care being expensive, not the ACA

as a point of reference, I wrote an economics paper when I was a junior in college about exploding health care costs, how health care costs were rising out of control, how health care would bankrupt the economy, and the pros and cons of single payer (called socialized medicine back then).
the year - 1978
It's only gotten worse

we are all paying the price for the failure of the "free market", insurers, government, and medical establishment from appropriately addressing the problem.

btw, I wasn't predicting the future back then any better than anyone else - it was a major concern in the press and politics. One of Ted Kennedy's major campaign issues in 1980 (he tried to get the nomination after Carter's 1st term) was health care.

[pcr3]

It will be interesting to see the effect on the election. Like I said earlier, I think (unlike most everyone else) this may actually help Romney by giving independents who oppose the law a reason to vote for a guy they don't like. Then again, November is a long way away and the economy will likely be the determining factor in the general.

But isn't the ACA based on the blueprint set forth in Romney's MA healthcare reform?  It seems like the Dems, if they play this right (which never happens), could take all that anti-"Obamacare" venom and use it against Romney.  And if he backpedals away from the MA reform, then he takes away his only positive accomplishment while governor or he looks like a flip-flopper.  This really seems like a win-win for the Dems, which means that Romney will likely get elected...

[Hicks]

I am still pretty stunned by this (obviously). The ruling feels to me more like Roberts, aware of the backlash over Citizens United, wanted to protect whatever legacy he has left and didn't want to be seen as heading up the "most radical right-wing court in history". I mean, he plainly rejects the Commerce Clause argument (which was the gov'ts primary justification) but allows the ACA to stand based on the taxing power which was barely discussed (although in hindsight I do remember during orals Roberts was much more pressing on day 3 in the taxing arguments than he was on the Commerce Clause on day 2). Like most everything in DC, it seems (to me) more like a political calculation than really deciding by the merits of the case.

In the end, it probably was unrealistic to think the Supreme Court would rule against a policy pushed by sitting president like that, something it hasn't done since Nixon. If there's a silver lining for me, it's that the limits placed on the Commerce Clause in the opinion potentially have more far reaching consequences than the result of the case itself.

It will be interesting to see the effect on the election. Like I said earlier, I think (unlike most everyone else) this may actually help Romney by giving independents who oppose the law a reason to vote for a guy they don't like. Then again, November is a long way away and the economy will likely be the determining factor in the general.

Also, LOL at the networks for having no clue what they are doing.

And of course (for VDB)...In the end.

Yeah you're nuts, no way a dude who will likely be serving for another 20+ years is letting "legacy" concerns drive his decisions at this point.

He just alienated all his buddies and supporters, if that's political calculation sounds like he forgot to carry the one and something tells me dude isn't that dumb.

[PIE-GUY]

I am still pretty stunned by this (obviously). The ruling feels to me more like Roberts, aware of the backlash over Citizens United, wanted to protect whatever legacy he has left and didn't want to be seen as heading up the "most radical right-wing court in history". I mean, he plainly rejects the Commerce Clause argument (which was the gov'ts primary justification) but allows the ACA to stand based on the taxing power which was barely discussed (although in hindsight I do remember during orals Roberts was much more pressing on day 3 in the taxing arguments than he was on the Commerce Clause on day 2). Like most everything in DC, it seems (to me) more like a political calculation than really deciding by the merits of the case.

In the end, it probably was unrealistic to think the Supreme Court would rule against a policy pushed by sitting president like that, something it hasn't done since Nixon. If there's a silver lining for me, it's that the limits placed on the Commerce Clause in the opinion potentially have more far reaching consequences than the result of the case itself.

It will be interesting to see the effect on the election. Like I said earlier, I think (unlike most everyone else) this may actually help Romney by giving independents who oppose the law a reason to vote for a guy they don't like. Then again, November is a long way away and the economy will likely be the determining factor in the general.

Also, LOL at the networks for having no clue what they are doing.

And of course (for VDB)...In the end.

Yeah you're nuts, no way a dude who will likely be serving for another 20+ years is letting "legacy" concerns drive his decisions at this point.

He just alienated all his buddies and supporters, if that's political calculation sounds like he forgot to carry the one and something tells me dude isn't that dumb.

Yeah, I gotta believe Roberts made this call on actual legal grounds... that's a good sign.

[runawayjimbo]

Rand Institute crunched the numbers and:

with Obama Care: premiums increase 7%

without passing: premiums increase 9%

YAY!!! The status quo wins again!!!

we are all paying the price for the failure of the "free market", insurers, government, and medical establishment from appropriately addressing the problem.

Don't forget soul-sucking lawyers!!!!

However, I'd be remiss if I didn't point out that it's not really a "free market" if the "gov't" is the most dominant player (which I now realize may be what you meant with the quotes).

But isn't the ACA based on the blueprint set forth in Romney's MA healthcare reform?  It seems like the Dems, if they play this right (which never happens), could take all that anti-"Obamacare" venom and use it against Romney.  And if he backpedals away from the MA reform, then he takes away his only positive accomplishment while governor or he looks like a flip-flopper.  This really seems like a win-win for the Dems, which means that Romney will likely get elected...

Do I expect Romney to repeal Obamacare if he's elected? Fuck no. But I think it could move the needle for independents in key states (CO, FL, VA) who would vote for Obama if the ACA was struck down.

Yeah you're nuts, no way a dude who will likely be serving for another 20+ years is letting "legacy" concerns drive his decisions at this point.

He just alienated all his buddies and supporters, if that's political calculation sounds like he forgot to carry the one and something tells me dude isn't that dumb.

True, "legacy" probably wasn't right. More like "public perception."

But I agree with you guys from earlier that this may be Roberts signaling a move to become more of a moderate voice on the Court. So I don't think he cares that he may have alienated his corporate overlords. (Although did he really alienate them? Let's not forget, by voting to uphold the law he created a captive set of customers for the health insurance, pharma, & device industries.)

Yeah, I gotta believe Roberts made this call on actual legal grounds... that's a good sign.

Here's the thing about that: the first question was whether the Anti-Injunction Act applied, in which case the states would not have the standing to bring suit against the gov't until someone paid the tax in 2015. To this, all the justices (I believe) agreed the mandate was not a tax so the Anti-Injunction Act was not applicable. Roberts then rejects, rather sternly apparently, the gov'ts main argument that Congress can compel you under the Commerce Clause to engage in an activity (in this case, buying a product from a private company). But then he turns around and says "well you can't compel people to do something but you most certainly can tax them if they don't do what you want them to do." The logic is just so convoluted to me that it feels like it's being shoe-horned in, which is what leads me believe he backed into the result.

[twatts]

"well you can't compel people to do something but you most certainly can tax them if they don't do what you want them to do." The logic is just so convoluted to me that it feels like it's being shoe-horned in, which is what leads me believe he backed into the result.

I think he opined that you can't be "compelled" to do something under the Commerce Clause (at least in this case), but you certainly could under Congress' ability to "penalize" a certain action (or inaction in this case)... 

But yeah, I agree that it seems like he was searching for a way to make it work, and gave Obamacare a freebie by offering this particular solution...  Then again the idea of a Mandate via Taxing has been around for a while, and I think OB avoided using that argument for fear of seeming to "raise taxes" on the poor and unemployed...  In some sense, he has given the Right a victory in that they can now say OBCare raises taxes...

So messed up, yet I'm glad it was upheld... 

Terry

[sls.stormyrider]

Can't believe I forgot about the lawyers

And, by "free" I meant not only govt influence but the undue influence of large insurance cos that rig the game. that all said, the market for health care imo should not resemble the market for typical consumer items like tvs, computers, etc

Obviously, only 1 person knows what Roberts was thinking. Maybe he likes the idea of universal health care and his goal was to fine a way to make it work.

Although I kinda get "the govt can't make me buy insurance", I find the other side more compelling - those who can afford insurance and choose not to buy it are costing me money and therefore impinging on my liberty.

As far as what this will mean in November, IMO most people against ACA were gonna vote for Mitt regardless of SCOTUS.
The vid of Mitt defending the mandate to the press and not calling it a tax has been all over the news around here. I suspect many in the middle will look at that vid, look at Mitt now, and say really, wtf Mitt?
That said, IMO the most important predictor of the race will be the state of the economy on November 1

[twatts]

As far as what this will mean in November, IMO most people against ACA were gonna vote for Mitt regardless of SCOTUS...

...That said, IMO the most important predictor of the race will be the state of the economy on November 1

Mitt needs to trend lightly on ACA, them DNC only has to point their finger at Mass and say "you did it too"...  His best shot is the state of the economy... 

But with WW3 looming (Iran/Syria poking at Turkey and the Euro collapsing), I'm not sure if it really matters...   :-P

Terry

[Hicks]

That's the thing your average voter isn't against Obamacare because of what it means in terms of policy, because who the fuck knows what this thing is actually going to do in the end anyway.  They are against Obamacare because they hate Obama. . . and probably puppies and ice cream too.  Those miserable dickbags are going to vote for Romney no matter what. 

[runawayjimbo]

"well you can't compel people to do something but you most certainly can tax them if they don't do what you want them to do." The logic is just so convoluted to me that it feels like it's being shoe-horned in, which is what leads me believe he backed into the result.

I think he opined that you can't be "compelled" to do something under the Commerce Clause (at least in this case), but you certainly could under Congress' ability to "penalize" a certain action (or inaction in this case)... 

But yeah, I agree that it seems like he was searching for a way to make it work, and gave Obamacare a freebie by offering this particular solution...  Then again the idea of a Mandate via Taxing has been around for a while, and I think OB avoided using that argument for fear of seeming to "raise taxes" on the poor and unemployed...  In some sense, he has given the Right a victory in that they can now say OBCare raises taxes...

So messed up, yet I'm glad it was upheld... 

Terry

But penalizing people for their actions (or worse, in this case, inactions) has apparently not been upheld under any SC interpretation of Congress' power to tax (according to Scalia in the dissent). But they can't call it a tax because then it would violate the AIA question. It's such faulty, circular logic to me. Roberts also cited Ben Franklin's "death & taxes" line as legal precedent in his opinion. It just doesn't add up IMO.

Interestingly, the part that was struck down - the Medicaid expansion - is most likely to make the Act far more costly. The CBO has already said it is reviewing the score but it will clearly raise the price tag when states start refusing to expand coverage and the federal gov't has to pick up the tab. I just don't understand how we'll ever pay for this thing.

There will probably also be some election year grandstanding between Obama and the governors (LA, IN, FL, VA maybe) who will refuse the expansion, and it will also likely make the GOP dig in even harder in resisting anything a second-term Obama would do so the polarization and politicaztion live on (or get worse). I'm not saying these are reasons why it should have been struck down, just that they are potential consequences of the decision that I'm unhappy about.

But, as always, sls is the voice of reason:

That said, IMO the most important predictor of the race will be the state of the economy on November 1

[twatts]

But penalizing people for their actions (or worse, in this case, inactions) has apparently not been upheld under any SC interpretation of Congress' power to tax (according to Scalia in the dissent). But they can't call it a tax because then it would violate the AIA question. It's such faulty, circular logic to me. Roberts also cited Ben Franklin's "death & taxes" line as legal precedent in his opinion. It just doesn't add up IMO.

Well, that's why its called an "opinion"...

It'll be interesting how this all plays out...

Terry

[Mango]

Man, never knew how educational the paug can be.
I can't say I have much input, other than knowing multiple students that are now covered and weren't before. I've got my own plan, but most of my buddies are covered under their parents.
Also diggin on the revamps in women's care, I dont have children yet, but I plan to be a midwife, and they've made some serious changes in the types of reimbursement that are required for care of the childbearing woman under Medicaid. The law requires reimbursement of birth attendants who are recognized by states for care within their scope of practice, which has always been a problem for midwives.. and also specifies that the Medicare fee schedule will reimburse certified nurse-midwives at the rate of 100 percent of the physician rate, replacing a prior 65 percent rate of reimbursement - Badass! For me, anyways.
Also pretty excited that it prohibits exclusion of coverage for preexisting conditions.. Did you guys know that some insurance plans have denied women coverage for their current pregnancy if they've had a prior C-Section? Or denied them coverage of pelvic floor dysfunction treatments after an episiotomy (that they probably didn't even know they were getting)? I mean, that is some fucked up shit! Glad there's some moves in place to have these rediculous provisions removed.

[sls.stormyrider]

Welcome.
All that stuff you mentioned is extrememly important, but got lost in the Tea Party noise because this whole thing is obviously a govt plot to control our lives. The WH needs to do a MUCH better job in communicating this other than saying "there's a war on women"

so - did a little bit of checking after hearing conflicting claims about health care costs in MA since the implementation of RomneyCare.

in 08, MA had the highest premiums in the country
in '10, 9th highest
healtblog.org rated MA as #1 for "cost effective" coverage, somehow rating amount and quality of coverage per health care dollar spent.

also, one needs to consider that MA, in particular Boston, has the highest concentration of teaching/ University hospitals in the country. This will almost invariably lead to higher costs
-teaching hospitals are more expensive for almost anything
-they tend to get more difficult cases, more unusual diseases, presentations
-they tend to get sicker patients
-the fact that there are 6 in boston alone makes is virtually impossible for a private, tertiary center (ie Washington Heart Center, Cedars) to establish roots and compete.

when my wife had her medical issues a few years ago, I was VERY happy we live here because of the choice of care and availabilty of high quality care even in the community hospitals out in the burbs

[Mango]

Welcome.
All that stuff you mentioned is extrememly important, but got lost in the Tea Party noise because this whole thing is obviously a govt plot to control our lives. The WH needs to do a MUCH better job in communicating this other than saying "there's a war on women"

so - did a little bit of checking after hearing conflicting claims about health care costs in MA since the implementation of RomneyCare.

in 08, MA had the highest premiums in the country
in '10, 9th highest
healtblog.org rated MA as #1 for "cost effective" coverage, somehow rating amount and quality of coverage per health care dollar spent.

also, one needs to consider that MA, in particular Boston, has the highest concentration of teaching/ University hospitals in the country. This will almost invariably lead to higher costs
-teaching hospitals are more expensive for almost anything
-they tend to get more difficult cases, more unusual diseases, presentations
-they tend to get sicker patients
-the fact that there are 6 in boston alone makes is virtually impossible for a private, tertiary center (ie Washington Heart Center, Cedars) to establish roots and compete.

when my wife had her medical issues a few years ago, I was VERY happy we live here because of the choice of care and availabilty of high quality care even in the community hospitals out in the burbs

Exactly. I was going mention that the whole individual mandate isn't much of a big deal to me, as I live in Boston and have it anyways! I actually work as a Primary Care Triage Nurse at Brigham and Women's, one of the largest teaching hospitals, and not only adore my health insurance plan (price and quality), but see the amazing quality of care we're able to provide to our patients.
Speaking of our higher costs, though, thought it would be interesting to mention what we're trying to do about it, so far... In recent years, the Brigham's begun moving towards a new model of care in Primary Care called "The Medical Home" thats aimed at leveling out health care costs, assuring positive outcomes for patients with chronic conditions (Diabetes, Hypertension, etc.) and prevention, prevention, prevention. One of the components of it is that their reimbursing MD's for positive patient outcomes instead of just SEEING the patient or ordering a test. They're paying much closer attention to long-term outcomes and prevention strategies in a move to lower health care costs overall. While this is a wonderful goal, its made a hell of a lot more work for me! - Though I must say its raised my confidence in the care we provide. I can clearly see how keeping track of these patients with the worst medical problems is slowly working to reduce ER visits and expensive interventions down the road. I have a lot of patients who are very grateful for our close management as well, and think its a wonderful model to work from (though it needs some work..)

[sls.stormyrider]

yep - the payment model needs to be changed, medical homes and ACOs will hopefully help in both quality and efficiency