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

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.

Greece is the word……….

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.

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

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 .

“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.

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.

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.

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.

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.

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.

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.

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

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

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

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.

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.

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

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. ;^)

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.

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.