What’s your reaction to the Supreme Court’s decision on the Affordable Care Act?

The Supreme Court has upheld most of President Obama’s health care overhaul. Today’s Question: What’s your reaction to the Supreme Court’s decision on the Affordable Care Act?

  • Mary

    I think this is Great news.

  • Steve the Cynic

    I think Roberts wanted to find a way to forestall our ultimate embrace of single-payer for another two or three decades by upholding this feckless half measure.

  • Kurt Nelson

    It is so hard not to gloat, but I will let my schadenfreude stay aside for now.

    I am surprised, as many are, that Roberts moved away from the Commerce Clause and into Taxing to validate the entire ACA. The oral arguments did not point that way, nor did many (most) of the briefs submitted in support. But this is what the Court correctly saw, and again validated the entire ACA.

    I have just started to read the decision, but at almost 200 pages of opinion, this might take some time.

    Maybe this is why Scalia was so cranky the other day in his dissent on Arizona, he knew he was on the losing side for both cases.

  • Gary F

    Greece is the word……….

  • david

    Woot woot!

  • matt

    In a stunning, unpredictable, shocker of a suprise, the govt ruled that the govt has the power to do what it wants. And, truly, the majority of the citizens want this as well. Finally, the majority of those who are against the ACA somehow think it is okay to tax for Medicare and SS so this not breaking any new ground. So we have an unfettered govt, a willing and or ignorant populace, and a new health care regime. Let the race begin – Gary F and Steve the Cynic – which one will be right …my money is on you Gary.

  • JMM

    For everybody who’s flippin’ out in either direction- relax and take a deep breath, let’s see what works. I one thing I know for sure – it’s better than starting a war.

  • James

    Good for John Roberts. Good for us. Now, let’s start getting costs under control too.

  • Gary F

    Think the economy is bad now. Wait until all the Obamacare taxes go into affect January 1st.

    For the people that think we need to be more like Europe, we are running just behind of Greece, Spain, Portugal, and Italy.

    Better start figuring out who John Galt is.

  • Jim G

    For now, I am awarding Chief Justice Roberts the Medal of the Courageous Heart with a Cluster of The Thinking Brain.

    Now we need to be prepared for those flying monkeys and elephants. They are a mischievous and meddlesome bunch .

  • Kurt Nelson

    @ Gary,

    The earliest the ACA tax will effect anyone is 2014, so this coming Jan 1st will only bring the new year, but alas, no new tax. You could repost next year and you would be spot on.

  • georges

    “John Roberts snookers the liberals. He Steals their Machine Gun in Broad Daylight!!!”

    That is the REAL headline.

    The Commerce Clause was the machine gun by which the Statists could Rule over everything and everyone, forcing the People to bend to the Federal Governments will.

    And Roberts took it from them.

    “In a daring daylight heist, John Roberts stole the coveted Universal Power, the Commerce Clause……”

    HarHar

    Look for the Libs to wake up sometime next year, saying, “Hey…….wait a minute…….just wait a DAM minute here, fella………”

    There’s a sucker born every minute…….every second………

    Har

    A tax is just a tax……and can be easily ended at any time……

    The Commerce Clause, on the other hand, is the CONSTITUTION, and cannot be stopped or changed with ease.

  • Kurt Nelson

    @ geroges,

    But the same Article 1, Section 8, that gives us clause 3, the Commerce Clause, also gives us clause 1, Congress shall have the power to lay and collect taxes… See right their in the constitution.

    I do not disagree that the Commerce Clause has been expanded beyond original intent, re: Wickard, Raich, Lopez, but the Chief Justice would not concede to the liberal majority a CC argument. By putting his argument behind the Tax authority, he leaves open the potential for a more narrow reading of the CC in the future.

  • Ann

    I am guessing that the people who are against it are the people who get health care through their employers or the taxpayers(Medicare). I think that that cadillac benefits should be taxed because it isn’t fair to have all that untaxed income and have others pay their share of taxes on that money.Let Congress try to get health insurance on the open market with people like me–health care reform would take place in a hurry! Normally I agree with Republicans, but not on this. They are trying to scare us with TV commercials–just like they did when Hilary Cllinton tried to bring reform.

  • georges

    The Tax Clause has not been, and indeed could not be, used to control every part of every citizens life, like the CC has been allowed to morph into.

    Any tax can be ended at any time. Each tax is an indivdual law, not in the Constitution.

    If the Supreme Court had put its stamp of approval on using the Commerce Clause in the abusive and bullying way the libs want to use it, to wit, to force people to buy something they do not want to buy, it would have created a permanent transfer of power from the people to the Federal Government, and would have been codified in the Constitution.

    Roberts made sure that would not happen anytime soon.

    The libs will figure this out someday, and then, feel………so………..used…………

    HarHar

  • Clark

    I find it interesting that a conservative justice provided the majority supporting obamacare. Unlike those on the looney left, it appears smart conservatives will actually make a decision based on the constitution rather then their own political viewpoint.

    Clearly shows the stupidity, ignorance and political motivations by the four liberal members of the supremes.

    Makes you wonder what moronic law the four liberal justices, would not support, if it originated with the looney left.

    As companies do the math and people begin the lose their employer sponsored health care in 2014, curious how the crazies on the left will manage the spin.

    The official moocher population just increased by 32 million. Moochers for obama.

  • Gary F

    Kurt, you are correct. Give people all the good stuff up front then sock it to them later after the election!

  • Emery

    The reform itself is not popular, but if you ask Americans about the individual aspects of the reform, they like them. This suggests to me that Americans, as usual, are uninformed about the details and have swallowed the spin.

  • Steve the Cynic

    Some years ago I befriended a certain man who lived in a nursing home. For the sake of confidentiality, let’s call him Fred. A few years before I met Fred he had suffered a stroke and was unable to care for himself. He was never married and had no children. In fact, he had no living relatives that anyone knew of, and his only friends were other residents of the nursing home. I had many enjoyable conversations with him before he died. The professional care he got at the nursing home, at government expense, enabled him to live with some measure of dignity. An organization dependent solely on charitable contributions could perhaps have kept him alive, but not much more than that. And of course there would be no hope of the Invisible Hand providing anything for someone who’s unable to pay. There are more folks like Fred than most people would guess.

    I was proud to be a part of a society where people like Fred could be cared for and would not be left to die in squalor. And I’ve now known several Freds. Caring for the Freds of the world is something that is everyone’s responsibility in general but no one’s in particular. Pooling resources to pay for such things is a legitimate role for government. The cost should not be borne only by those who are generous enough to give to charity. Skinflints should not be allowed to shirk their duty to their fellow human beings. But to hear some small-government zealots rant, you’d think they would be just as glad to give Fred a euthanasia drug and say, “Now take care of yourself.”

  • Mike

    This allows us to get back to the heart of what health care reform really means. It is a massive tax increase on young people and small business to pay for health care for old and poor people. The unpopularity of the mandate will translate into relatively small penalties for not joining. Companies will abandon their health plans, pay the penalty, and leave everyone to the exchanges, the subsidies for which will overwhelm the government in excess cost.

    And then we’ll see the real reform. It’ll probably look a lot more like Paul Ryan’s plan than Obama’s.

  • Steve the Cynic

    Oh, I hope not, Mike. A society that doesn’t care about the old and the poor is not one I would be proud to be a member of. Real reform would involve learning from Canada’s experience, where the health care system works, not perfectly but well, and people like it. The fact that the richest country in the world doesn’t have universal coverage already, and won’t be getting it even with Obamacare, and now seems to want to back off of even that half-measure, is embarrassing.

  • Meg

    No one wants to have the difficult discussion about end-of-life care and some pieces of health care where it’s just wasteful and expensive.

    There was going to be a payment for doctors on Medicare to have a discussion with patients about what they’re end-of-life wishes would be. And that suddenly became this huge conflagration about death panels and rationing. I mean, that was really not rationing, and yet that’s what it turned into. And, unfortunately, it’s really the best thing that you can do, to talk about if you’re 89 years old and you need chemotherapy for $200,000 versus insuring five 26 years olds, no one wants to have the discussion.

  • Mike

    I’ll bite on the troll…

    Countries that invest the surpluses of their workers in the old are in decline. Those that invest those surpluses in the young will thrive. When we sacrifice education and infrastructure to pay old age pensions and medical bills, we place ourselves inexorably on a downward spiral. Capable young people will not raise their children in a society that sacrifices the future children for the comforts of the aged. The good ones will leave, and the poor ones will refuse to work hard.

    Does this mean we abandon the aged, put them out on an iceflow to die out of our sight? No. It means that we must make difficult choices to treat maladies with public dollars when those treatments result in additional healthy, productive years of life, rather than a few months of painfully delayed decline towards death. It means that the elderly should be expected to work, albeit with fewer hours in less demanding positions, until death is fairly close at hand. Retirement cannot be a state-subsidized 20 year vacation in the sun if we are to progress as a society. If the baby boomers want to break with their established pattern of self-absorption and actually do something worthy, they’ll embrace limiting the transfers of wealth to the elderly, focusing on the children instead. I’ll not be holding my breath waiting for this to happen.

  • Steve the Cynic

    Yes, Mike, it’s a mistake to go too far the other way, too. And perhaps we have, especially considering that our official retirement age has not kept up with increases in life expectancy. But teaching kids that they should honor their elders (and to be less selfish in general) is also a good thing. And I challenge your apparent assumption that the value of a human life is related to how productive it can be.

  • Mike

    Investments in electricity, internal combustion, or computing (for the most part) lead to a more productive society. We are investing wealth, but we are producing the potential for more wealth. That is what generates growth. Investments in medicine (for the most part) lead to longer lives for retired people who are no longer producing. Even when younger lives are lengthened, all that is returned is more humanity, something for which there is no shortage. Medicine is a luxury good, which does not generate further returns. I will happily make exceptions for vaccines, clean water and antibiotics, but the sparsity of the list of medical technology that makes society more productive is revealing. A society that invests in medical technology, rather than technology that makes us more productive, is a society that is no longer focused on the future, but rather one that indulges our present fear of death, a fear that increases as we become less productive and more a part of the past than the future.

    I also find the expansion of the health care industry vaguely unsettling. I keep thinking of hospitals like the pyramids of ancient Egypt – monolithic transfers of wealth to the dead. It is not exactly rational, but then again, what are the fiscal multipliers in the health care industry?

  • Mike

    You can’t just have the elderly buying their own individual health insurance without putting in place a fairly elaborate system of rules and regulations to share the costs and ensure affordable coverage. Otherwise, what may represent a subsidy of 80% of the cost of health care for an average elderly person might only be 20% of what an old person with diabetes would be charged, and 1% of what an elderly person recovering from chemotherapy might be charged (if they could get private insurance at all, which they won’t). Market-based solutions to health care need to deal with the problems that make health care a poor market. Many health care costs are all too predictable, so it always pays for insurers to try to discourage and/or charge exorbitantly those who are sick or likely to become so. Privately purchased health care only works if you regulate that all customers must be charged the same, and all buyers must be accepted. Either that or some sort of subsidy system where insurers who take on patients with specific long term maladies receive a bonus to compensate the predictable extra expenses. This is close to the Swiss system, which while private is highly regulated. It’s not as simple as Ryan makes it out.

    That being said, the transfer of wealth from young working Americans to old indigent Americans must have a limit, and it would be better if America’s elderly rather than the government decided which forms of expensive health care they would rather do without. T

  • T

    Thanks Mike for your insight into healthcare in general. Few seem to want to state this in such plain terms. I see this day-to-day as a physician and couldn’t agree with you more. In my world of pediatrics, there is a large focus on prevention, but few want to put resources in that direction, including parents. We have become complacent and reliant on technologies that do not improve a healthy lifestyle. Gadgets and games leave many sitting on the couch will do little to prevent our overt laziness. Think WALL-E but here on earth. I think we need a level of economic breakdown to change the balance seen today.

  • matt

    Mike,

    I think you are tackling the tough reality on this and appreciate that. In the end it is damn hard to say no to spending on health care and eductation. There can never be enough of either but the marginal benefit (not specifically a $$ issue but over all utility benefit) just is not there.

    The other side of this coin is what can be done to pull wasteful costs out of the system? Eliminate patent laws, allow drugs to be administered with an informed consent model (they can still go through a formal approval process for a protective measure for those who/want need it but no reason to restrict them from others), increase the transparency in pricing by making the patient more of the customer rather than the pawn between insurer and provider. There is a huge bubble in health care because of these market distortions. If we could deflate that bubble we would turn this mountain into hopefully just Buck Hill. Sadly the ACA does not address any of these concerns and just adds more technocracy that will allow the bubble to grow more. MBA’s, Wall Street and the 1% will milk the hell out of this cow.

  • frank wright

    Christ provided health care to all those in need that he came across and wanted us to build a society that would do the same. Why are Republicans so opposed to doing this?

  • matt

    @frank wright

    Republicans are opposed to democrats and vice versa so I think that is the bigger dynamic here. Republicans probably got a big break with the SCOTUS ruling, if it had been ruled differently (lots of possibilities) it could have opened the door for a challenge on Medicare and SS. I am quite certain the GOP would have messed themselves if they had to take credit for the dismantling of either of those. 20 years from now this will be as untouchable to Republicans as those two programs are now (they will always talk about “reform” but no serious effort is ever actually mounted…just enough lip service to keep the base happy).

  • David Poretti

    @ georges Instead of thinking of the AHCA has a government jackboot on your wallet, think of it as a “no free riders on America’s Health Care system” program. Before this act, we all had health care. Some just choose not to pay for theirs, and use the ER has their primary care clinic. A very expensive option, and paid for by all of us tax payers with insurance. Now, by requiring folks to either have insurance or pay a tax, their will be no more ER abusers that we have to collectively pay for. Government has always used taxes as a way to manipulate behavior. Why do they offer tax incentives for married couples? For making babies? Or, 10 years ago, for buying gas hog SUVs?

  • georges

    David

    It looks like you bought into the propaganda.

    The Free Riders will be the same.

    First, they will be exempt from the penalty/tax for not having insurance, up to a certain income, just like they are now exempt from the income tax. They will probably even get cash “payments”, just like they do now with the income tax.

    Additionally, even if the low income Free Riders do get assessed a penalty/tax, the FedGov will never attempt to collect it. Nor will they arrest or put the low incomers in prison.

    The Middle Class, yes, but not the so called “poor”. Won’t happen. How would that look? Besides, as we all know, you can’t get blood from a turnip.

    So, the low income free riders will continue to get their care anyway they can, including the ER, and not have a care in the world about penalty, or tax, or buying insurance, or paying for it.

    “Why do they offer tax incentives for married couples? For making babies? Or, 10 years ago, for buying gas hog SUVs?”

    To buy the votes necessary for their re-election, of course. No big mystery there. And they buy those votes with the money of the grandchildren of the people whose votes they are buying. Despicable.

  • matt

    @David,

    The idea that this prevents free riders just doesn’t pass the smell test.

    1. People unable to get health insurance prior to ACA still received health care – they paid out of pocket, got state aid, or defaulted on medical bills.

    2. People unable to get health insurance (as an aggregate group) consumed less medical services – limited by finances.

    3. For those who could not get health insurance due to costs nothing has changed (regarding their income as a result of ACA) so they cannot pay anymore for medical care than they did.

    4. Because ACA will remove the financial constraint in #2 there will, all things equal, be more health care consumed by them.

    Summary – payments from this group will not increase and demand for services will increase. This is not meant to be a value judgment on the effects simply an logical analysis.

    The additional income into the system is from healthy people, who consume very little health care, and do not pay insurance. For those this is a straight loss as they will not, all things equal, increase their health care consumption but will be making additional payments. The pool of people fitting this description is far smaller than the first pool. The tax levied against uninsured will not be enough to cover the increase of services coming from the first pool so the gap will be covered either by govt spending, increased rates on the balance (people who have insurance now), or by reducing health care elsewhere.

    Without dissecting the implications of the ACA in its entirety it is possible that the increase in availability will increase economic activity by freeing those people bound to a job/location/etc by a need to continue their insurance. I dont think this will be insignificant but doubt it will be enough to overcome the “free rider” issue.

  • Steve the Cynic

    Mike, you seem to be saying that human life is valuable only to the extent that it is “productive.” What do you mean by productivity, and how do you measure it? If your premise is that economic prosperity is the highest good and that the quality of our health care system should be measured against that standard, I reject that premise.

  • David Poretti

    @ Matt @ georges I don’t think you read my earlier post clearly. I defined a “free rider” as someone who chooses not to purchase insurance and relies on tax payers and the insured to pay for their care via the emergency room. The operative clause in defining a “free rider” is chooses not to purchase insurance. Not that they can’t (because of their financial or current health status), but because they choose not to, and then they rely on the rest of society to cover their ER medical expenses. This tax will still allow anyone to opt out of buying insurance, but they will be part of the pool that pays for their ER care.

  • Mike

    The only way out of the gerontocracy trap is to simultaneously offer Medicare for all. You can’t reform Medicare because to do so is an attach on seniors, which they will fight. You can’t means test Medicare because middle class seniors (the ones who vote the most) know that they will be paying more. But if you offer Medicare to all, reform is absolutely essential, and it will be harder for the seniors to argue about means testing when the young are paying 80% of the premiums and the old are taking 80% of the services.

    So if you are a conservative, you start by offering Medicare to all. You make the annual dues for young people astronomical for the full plan, so you offer them cheaper versions of Medicare which are not fee-for-service, or high deductible and co-pay, and/or run through private insurers. Then you tell the seniors that they have to move to the cheaper versions of Medicare if they want to avoid fees, fees which are means tested. This will take a decade or more, but if we don’t pursue a path like this, the politics become impossible.

    The takeaway lesson is that you can’t privatize or otherwise reform Medicare unless you make it universal, first

  • Mike

    We’ll be seeing a lot of this in years to come. The social spending which is growing fast is almost all transfers from the working young to the idle old. The Democrats had better watch out. They’re already the party of the public sector unions. If they allow themselves to become the party of the recipients of federal spending, and allow the Republicans to represent taxpayers, the taxpayers will win in the end. You can’t be a responsible party of government while claiming that Medicare will never change.

  • Mike

    Health care reform would best be carried out at the state level, where budgets must be balanced, and choices made. Changing Medicare and Medicaid into block grants for the states, draconian as that might first appear, would in fact allow the freedom for real reform to happen.

    Enjoy the weekend everyone., my work here is done. ;^)

  • Meg

    I want to thank Mike and “T” for expanding on my previous comment earlier.

    I’m so pro-public health and so incredibly happy that people are covered. It’s solidarity. It’s the right thing to do. It’s what they do around the world. It’s what humane, ethical societies do. But they also need to talk about cost. And I just don’t know why it’s so difficult to sit down and have those types of discussions and somehow be called inhumane or unethical and that’s really what it is.

    And I think the physician “T” made the comment about, you know, physicians not being paid for care and being paid for procedure, and they want to be paid for care. And there’s new programs like Pathways and evidenced-based medicine that does that. But, man, if you can’t get a little bit further, suddenly, it’s a death panel, which it never was. To a degree it is rationing. And, yeah, I said it. So there you go.

  • georges

    David

    “I defined a “free rider” as someone who chooses not to purchase insurance and relies on tax payers and the insured to pay for their care via the emergency room.”

    Yes, and virtually all of those Free Riders are poor or very low income. Young people who are part of the Middle Class either have insurance through their employment or choose not to buy it. The working middle class that choose not to buy insurance, be they young or middle aged, do not spend their time hanging around the Emergency Room in order to get free care. That is almost entirely the experience and desire of the poor, low income, and illegal aliens.

    Young working middle class who choose not to have insurance will immediately change their minds after a single experience in the ER, and begin to buy the insurance. The ER is a very unpleasant place to be. Getting care there is a long, time consuming, eratic, impersonal, disgusting, unreliable, undependable, shallow, superficial, disconnected, and maddening experience that the vast majority can not stand and would not put up with. Again, you have bought the propaganda. It really isn’t that way.

    ” The operative clause in defining a “free rider” is chooses not to purchase insurance.”

    No, the definative idea that makes one a Free Rider is using the ER for primary care. If one chooses not to buy insurance, but never goes to the ER, then one is NOT a Free Rider.

  • Glenn

    Let’s see-

    The Republican Party was scared to death this law would initiate a single payer system- so they pushed thru the private heath insurance idea to handle the issue. That is what they wanted- that’s what they got.

    The ‘tax’ vs. ‘mandate’ issue seems a moot point- considering the publics interest in the final result.

    At any rate- the existing HMO health care system is broke- and can be fixed. I’d prefer to see the people get the same health care oppertunity the legislators use- but that was never discussed publically. Why they didn’t simply give us what thet got confuses me…

    My point is- we must try something. The current HMO system has failed. We have learned that when the medical administrators decide the dollars- they have guarded thier own pockets and let the rest of the system mire in foolishness. When the fox watches the chicken coop……HMMM

    Int the end result- the court put the publics interest and protection in the front of the issue- as it should be.

    Glenn

  • Doug

    Emery said it best: ["Americans, as usual, are uninformed about the details and have swallowed the spin."]

    Approximately 6% of the public will be affected by the so-called free-rider penalty. And they will have done so of their own free will.

    The vast majority of the American public have employer issued health insurance. I would also like to remind folks that this employer based health insurance is a non-taxed benefit to the employee. Are benefits not a form of compensation and therefore be treated as wages? And to the employer, the government allows for tax benefits (subsidies).

    Providing health care is a tremendous distraction for business. It gets employers involved in aspects of the employees’ lives where they don’t belong and aren’t comfortable. Much as you don’t want your employer making life or death decisions about coverage for one of your family members, your employer really doesn’t want to be in that position either. I fully expect to see a trickle of businesses, starting with small ones, dropping their employees onto the exchanges, which will grow to an avalanche. Health care insurance from your employer will become rare.

    If you feel the need to tax compensation, then make it a fixed percentage. Better yet, put in a national value added tax to pay for health care and tax consumption.

    The Republicans are very unlikely to repeal the health reform law. But they could improve it by paring back the minimum plan to a high deductible, high co-pay plan with a maximum on the co-pay.

    In general, businesses would be better off if they got out of the benefits business and paid only in cash. All forms of compensation should be taxed with no exemptions.

  • Dennis

    They better end the War on Drugs and end the Prohibition of Cannabis if they wish any real good to come from this mess.

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