US Supreme Court upholds healthcare reform law

[Eist]

www.bbc.co.uk/news/world-us-canada-18630837

I would like to discuss with anyone that is interested in this decision.

I am cautiously in support of this decision.

I support that the most desperate 50 million Americans are now able to get the healthcare they need, and that many more can do so without their lives been completely shattered. I support that a new-born baby with a genetic defect won't be discriminated against, nor will it bankrupt the family it is born in to.

I support that this is probably one step closer to the overturn of a completely corrupt, heartless, and broken industry, and into the first world where we have a single-payer system. In saying this, I have some reservations regarding a "good enough scenario" and what this means for the eventual passing of a true universal healthcare system and the concurrent removal of the mandatory nature of the healthcare insurance industry.

Discuss

[Aersoldorf]

Eist I'd be happy to discuss this with you. I took the AGAINST side in the University debate recently on this very issue. I'm not able to afford the insurance that they offer at my place of employment at this point in time and haven't carried health insurance in almost a decade. Now the government wants to penalize me for my choice? I haven't been to a doctor in almost 20 years and we've always paid cash if one of the kids had to go. This decision takes away my ability to choose what I want to do and places a severe financial burden on me. My hope is that the Republican party will win the election and repeal this garbage.

[Eist]

The problem I have with your reasoning, Aerso, is that it does not benefit you in the long run (I’d hate to see the burden on your family if you became gravely ill – you are essentially playing with fire being uninsured, and I feel bad for you and your family.) The financial burden you talk about is miniscule to the cost that would have been incurred had you needed hospitalisation without insurance. It’s that the fact that healthcare is (but soon won’t be) only available to the best off in society that is the issue. The lower category, and this includes you since you say you can’t afford healthcare, is completely at the mercy of the system.

If your family is below 133% of the poverty line (FPL), then your family is now eligible for Medicaid. If you fit into this category, take it for your family. If you are above this, then make it so you can afford it. It’s tough if you are just above this line, of course (for years my wife and I were below it – so I know), but you owe it to your family. Because it is a tax system, those that earn less, pay less into it, which is completely fair. If you make money off the poorest people, then you should give back to these people.

The Republican mantra of reducing freedom, or, worse, supporting socialism/communism, only exists because the Republicans are the problem – as they are financed by the groups that are complete wastes of space but still exist well out of their necessary lifetime – the Healthcare Insurance industry.

This is not about choice or freedom. It is about starting to curb the systematic abuse of the most vulnerable in society by the most advantaged.

You can’t just gamble on not getting sick. It’s degrading to your family.

[Eist]

This is an interesting infographic on the reform of the Heathcare system

Please read it first, and if you disagree with anything, then feel free to say it

[Aersoldorf]

Jun 28, 2012 17:36:09 GMT -5 Eist said:

The problem I have with your reasoning, Aerso, is that it does not benefit you in the long run (I’d hate to see the burden on your family if you became gravely ill – you are essentially playing with fire being uninsured, and I feel bad for you and your family.) The financial burden you talk about is miniscule to the cost that would have been incurred had you needed hospitalisation without insurance. It’s that the fact that healthcare is (but soon won’t be) only available to the best off in society that is the issue. The lower category, and this includes you since you say you can’t afford healthcare, is completely at the mercy of the system.

If your family is below 133% of the poverty line (FPL), then your family is now eligible for Medicaid. If you fit into this category, take it for your family. If you are above this, then make it so you can afford it. It’s tough if you are just above this line, of course (for years my wife and I were below it – so I know), but you owe it to your family. Because it is a tax system, those that earn less, pay less into it, which is completely fair. If you make money off the poorest people, then you should give back to these people.

The Republican mantra of reducing freedom, or, worse, supporting socialism/communism, only exists because the Republicans are the problem – as they are financed by the groups that are complete wastes of space but still exist well out of their necessary lifetime – the Healthcare Insurance industry.

This is not about choice or freedom. It is about starting to curb the systematic abuse of the most vulnerable in society by the most advantaged.

You can’t just gamble on not getting sick. It’s degrading to your family.

I know that when I was out of a job and drawing unemployment that my earnings from unemployment put me over the limit to be able to have Medicaid.

[-Valoniah-]

Aerso, you sir are a fine example of how this decision will hurt people.

As for myself, I just don't like the Fed telling me what I can and can't do with MY MONEY!

[Aersoldorf]

Amen. If people would take the time to read the Constitution from time to time they'd discover that the Federal Government doesn't even have the RIGHT to intervene in my life in this manner.

[Eist]

Admittedly, in NC it is a pathetic situation, but you must have been doing ok for yourself.

www.census.gov/hhes/www/poverty/about/overview/measure.html

I'm not a fan of the Medicaid system, but, now, under the new reform, the threshold is even higher (for the vast majority.) You seem to be advocating for this.

I won't be satisfied until healthcare gets the exact same representation as schools, roads, and the police and fire departments.

The analogy here is that if your child was kidnapped and the police would only look into it if you have police insurance or could fork over a couple of grand to pay for the service. It really doesn't make sense. That's not increasing freedom. It's insanity.

It's the same thing. Status quo has a lot of power.

[Shemiki]

Up in Canada, we pay for a free healthcare system through taxes. While this means that the tax rate is higher, and there is a waiting list determined by the severity of your illness or injury, it at least allows everyone a fair chance at the system. Both systems have their ups and downs. As for the problem down in the US, I agree with Aerso: You should be able to do what you want with your money, as the way I see it your the one not taking the chance to have a better ability to use your healthcare.

[Eist]

Jun 28, 2012 18:09:24 GMT -5 Shemiki said:

You should be able to do what you want with your money

If you have the money. If not, you are screwed.

Jun 28, 2012 18:09:24 GMT -5 Shemiki said:

as the way I see it your the one not taking the chance to have a better ability to use your healthcare.

I don't understand what this means, sorry.

[Shemiki]

What I mean is, if you don't want an insurance for healthcare, don't take it. You're only refusing the chance. As for if you don't have money, I guess you can't take it in the first place.

[Calanria]

It's interesting that Chief Justice Roberts upheld this decision on the basis of Congress's power to levy taxes rather than the commerce clause.

A comparison was made on NPR to the hypothetical situation of Congress mandating the bearing of children and attaching a tax penalty to the mandate.

It was a ridiculous analogy, to be sure (I don't envision the US mandating having a child in the near or far future ), but it does beg the question of whether or not this ruling will be used to mandate other things based on the levying of taxes as a penalty of non-compliance.

[Ad Infinitum]

This is great for everyone who already has health insurance, and for the slim majority (Aerso's camp) it'll be a financial inconvenience.

I say this is great because it is. Previously, the health insurance companies could run rampant and charge whatever the hell they wanted until they decided an individual was no longer profitable anymore, at which point they could simply claim they had exhausted their coverage and dump the sickly.

In addition, doctors will soon be paid at a rate commensurate with the quality of their care, as opposed to the number of patients they treat (as it is currently). This will lead to longer times spent in the waiting room, sure, but ideally this will mean fewer trips to the doctor. If a physician is going to get paid based on quality, they're going to do a damn good job making sure each patient is thoroughly healed before sending them off. This could turn your annual physical into a more thorough checkup every few years.

All of this is designed to drive insurance rates down. There's currently no regulation for how much an insurance provider can charge a customer. In fact, there is absolutely zero oversight over medical insurance providers. They're making a fortune and there are people out there with life-threatening illnesses that are afraid to go to the doctor for fear of driving their insurance rates up, who couldn't afford to go to the hospital without coverage.

I'm firmly in the position that this is going to suck pretty hard for everyone for a few years. People who already have insurance probably won't even notice a change, but those without (a solid minority of Americans, I should add... somewhere around 20% according to 2010 Census data) are going to have to bite the bullet initially, at least until insurance providers are able to reduce their rates due to holy-crap-everyone-in-the-country-is-suddenly-buying-their-service induced profits start rolling in.

And here's the best part! They can't raise their prices just for profit once everyone has it. Their profit margin will be capped. They will be required to offer lower rates at a certain point.

So yeah, it'll suck for a little while, then it'll be better for everyone. The only reason it's "required purchase" of insurance rather than just a nation-wide tax, like how Canada does it, is because it's still going to be a free market. The companies the people favor will do better, as opposed to all insurance providers just being shut down due to redundancy.

Just be patient and it'll all be fine. People have some sort of attachment with looking at just the immediate future when one of these changes sneaks up on us, but really, there are a lot of benefits to this plan that far outweigh the immediate cons.

[Half-Life Universe]

Although I applaud the general idea, forcing it down people's throats just seems...wrong.

[Eist]

Jun 28, 2012 20:49:11 GMT -5 Half-Life Universe said:

Although I applaud the general idea, forcing it down people's throats just seems...wrong.

In this context, every single service that you receive that you benefit from through paying tax is "forcing it down people's throats"

[Ad Infinitum]

Jun 28, 2012 21:11:32 GMT -5 Eist said:

Jun 28, 2012 20:49:11 GMT -5 Half-Life Universe said:

Although I applaud the general idea, forcing it down people's throats just seems...wrong.

In this context, every single service that you receive that you benefit from through paying tax is "forcing it down people's throats"

Yeah, damn those firemen and all that infrastructure.

[MinnaCaroline]

I like so much about it! The birth control for one, the fact that my kids can be insured with me until they are 26. Its definitely going to be tweaked through the years but like PAI said, nothing is instantaneous and sometimes you have to wait to see the good come out of it.

[NeoYundar]

last i checked I'm 26 and havnt been a child since I left home at 18. I feel that this healthcare is a blatent violation of my rights. the government gives nothing, its just takes things away.

[MinnaCaroline]

It doesn't matter if you're living with your parents or not, you still get to be on their health plan until the age of 26. That's 8 years of my kids living on their own that they don't have to worry about health care or paying for it out of their paycheck when they get their first jobs out of college, for me that's peace of mind.

If one of my kids gets sick I don't have to worry that they can't cover themselves or pay for the hospital. Since I'm one the who pays for the healthcare in my family I'm glad that I can do this for my kids.

[Eist]

Yundar, your post makes no sense. I refuse to answer it because you seem to simply be ignoring the fact that almost everyone is getting something out of this, albeit that they are taxed for it.

On another note, this is an excellent summary of what you can expect from the changes

www.kaiserhealthnews.org/Stories/2010/March/22/consumers-guide-health-reform.aspx

[Shemiki]

I still don't see why people can't go without insurance if they don't want it.

[Eist]

Jun 29, 2012 10:05:09 GMT -5 Shemiki said:

I still don't see why people can't go without insurance if they don't want it.

The problem is the removal of any health insurance company's ability to reject a customer. You could just not pay for it, and when you get sick sign up for it.

It's completely unsustainable this way. It is necessary that everyone that can contribute, does.

I can't really advocate for the new system -- I think it's got a lot of problems that a true universal healthcare system does not -- but it's a step in the right direction.

[MinnaCaroline]

Jun 29, 2012 10:10:55 GMT -5 Eist said:

I can't really advocate for the new system -- I think it's got a lot of problems that a true universal healthcare system does not -- but it's a step in the right direction.

This ^

[Cerb]

Here's the problem:
1. More individuals below poverty level can get medicaid. Yet another incentive to stay on welfare.
2. The increased cost to support those individuals has to come from somewhere. That means it comes from the rest of us and is yet another blow to an already marginalized middle class.
3. It's incredibly unfair to tax someone because they don't wish to contract with a publically held company for their services.

If that had been tried in 1776 there would have been a huge outcry and a demand for the government to stay out of what Americans pay money for.

Health care reform is necessary, but it seems like this was a sorely half assed approach.

The people who suffer most out of this mess are the people who are struggling to make it. They are above the poverty line and trying to make progress with low wage temporary work, with companies that can't afford to buy in health care and stay afloat.

It never seems to occur to people that the organizations making the money, meaning the hospitals and insurance companies, now have a bigger pool of customers to exploit.

The only way this crap works is if the government builds and staffs the hospitals. They collect the insurance money, and they provide the service to everyone.

This mess of it being a private industry that you are forced to participate in is madness.

Sorry for the ramble.

Oh the only thing I like is the mandate that people can't be penalized for pre-existing conditions.
That's fair. I applaud it.

[Eist]

Jun 29, 2012 10:34:34 GMT -5 Cerb said:

1. More individuals below poverty level can get medicaid. Yet another incentive to stay on welfare.

I find it hard to believe that people are going to choose going on welfare because they can get healthcare. Nobody that is willing to work is going to make that decision.

Jun 29, 2012 10:34:34 GMT -5 Cerb said:

2. The increased cost to support those individuals has to come from somewhere. That means it comes from the rest of us and is yet another blow to an already marginalized middle class.

True, kind of. The middle class for the most part is doing pretty well -- not as well as they should be given the wealth and potential wealth flowing through this country -- the worst part being that more of the middle class is turning in to the lower class that you seem to despise so much.

We see here that nearly 50% of people earn under $25,000, which is not great. The majority earn over this, and it is a fairly flat distribution compared to under $25,000. This means that people that earn over $25,000, usually earn considerably more than this.

Jun 29, 2012 10:34:34 GMT -5 Cerb said:

3. It's incredibly unfair to tax someone because they don't wish to contract with a publically held company for their services.

Why? There are many government run companies that you already pay for.

Jun 29, 2012 10:34:34 GMT -5 Cerb said:

Health care reform is necessary, but it seems like this was a sorely half assed approach.

I totally agree. I think the problem is that of the Republican, neo-Cold War "we hate dem commies." They removed any possibility of removing the health insurance industry, and keeping the current completely unsustainable and wasteful system we currently have. The only possible effective system is universal healthcare. This is not it.

Jun 29, 2012 10:34:34 GMT -5 Cerb said:

It never seems to occur to people that the organizations making the money, meaning the hospitals and insurance companies, now have a bigger pool of customers to exploit.

This is my major issue with the new system. I assume it's why it was passed in the first place -- the healthcare industry has a very strong presence in the US political world.

Jun 29, 2012 10:34:34 GMT -5 Cerb said:

Oh the only thing I like is the mandate that people can't be penalized for pre-existing conditions.
That's fair. I applaud it.

Good, I do, too. Unless you are a pharmaceutical company, I can't see how you can't support the deregulation of generic drugs. It "increases freedom" of choice for consumers, while driving down the costs of the drugs.

[NeoYundar]

I used to have the right to choose to have or not to have healthcare, now I do not have that right. thus the government has taken something away. If the government can force me to buy something what are the limits of federal power? they can tax me for being single and force me to get married. they can tax me for not having kids and force me to do that. they can tax me into doing anything they want.

[Eist]

Jun 29, 2012 11:39:56 GMT -5 NeoYundar said:

I used to have the right to choose to have or not to have healthcare, now I do not have that right. thus the government has taken something away. If the government can force me to buy something what are the limits of federal power? they can tax me for being single and force me to get married. they can tax me for not having kids and force me to do that. they can tax me into doing anything they want.

Yes, but, "theoretically", you have the power to vote out the government that you don't like. If you don't like them, vote them out. That's how it works. Although, then undemocratic nature of American politics somewhat prohibits this. Anyway, that's another discussion.

You pay for a lot of services that are government controlled. Police, fire services, and roads are the obvious (but relatively small budget wise) services. Defence, social security and Medicare/Medicaid are the major services.

Does this make it right? No.

Unfortunately, the system was completely broken. 50 million people, including Aerso, could not afford healthcare. This is just unacceptable. In the richest country in the world, nobody should be going without it. People's health is too valuable. Not to mention non-insurance people are a huge burden on the tax-payer.

The only way this can work is if basically everybody pays into the system. This can only work if it is not shareholders demanding profits every financial quarter. Healthcare should not be dominated by the private sector; we can see that this does not work.

I think this sums up the cost of private healthcare. Please don't think this is because the US has the best healthcare in the world -- because she really doesn't.

[Cerb]

I need to complain here Eist,

Making an assumption that I despise poor people is neither fair or accurate. Please debate the points without attempting to cast disparaging remarks about what you think I feel.

I lived below the poverty line for 30 years and it's only in the last 8 or so that my wage has increased to where I am laughably referred to as middle class. If it's middle it's waaaaay at the bottom end of middle.

I don't appreciate the disrespect.

I neither despise or wish to beat down poor people who are working to improve themselves. I do not believe that making people dependant on a welfare state is wise.

A safety net is important, but it has to be very carefully balanced so that individuals see the benefits of rising out of poverty. If they cross over the poverty threshold and now have more bills they may as well drop back a notch so they get their free health care etc.

That's the problem with this system. It is entirely ill conceived and rather than fixing a problem, they have merely made it more complex.

The best part of this thing is that John Roberts actually did a very smart days work by upholding the law, but very clearly illustrating that this is a tax, and it's a huge tax. That gives congress a lot more power and I honestly think he's playing a longer game than just throwing it out on a marginal vote on party lines.

[Eist]

I apologize, Cerb, my comment was out of line.

In saying this, I despise your (albeit well informed) attitude to those that are reliant upon the government for assistance. Sure, some of these people are scamming the system, and are parasites to the country. It's disgusting. But, most are honest and hard working people temporarily down on their luck. It is very difficult to separate the two groups. We should be trying to support people as much as possible to become valuable members of society again.

Not only do I not think that people will try and get under the percentage of the poverty line so they don't have to pay for healthcare, because if you are just over it, the costs in the form of taxes are miniscule, anyway, the problem is tiny compared to, say, the richest people not paying a decent share of the load.

I can't disagree with any of your other points.

[Cerb]

Thanks for the apology.

My attitude to those "poor" is aimed directly at the scammers, not the hard working people down on their luck. These individuals often rise back out of the poverty level. They are using the safety net as it was intended.

I've met far too many of the other sort that not only admit they are exploiting the system, but they are proud of it. They even have an almost supercilious attitude regarding their entitlement to live off the state.

Those that I speak of on the margin are the ones who suddenly cross the line from getting medicaid and are now forced to buy medical insurance either on their own, or through an employer. I think my personal contribution to my insurance is about $95 a week.

Can you imagine trying to do that when you are barely making it? If a person is making about $30K a year, it's a lot to ask them to pay about a 6th of that on medical insurance.

What I am trying to point out is that this could well end up screwing the poor people. Not the severely poor but those on the borderline.

If you want to make it fair you establish a flat % tax that funds a state medical program. Then allow people to buy private health care if they want something better than the state has to offer.

Now the insurers know that people have to buy insurance or face a penalty. That sounds more like a capitalist ploy than something to help the poor.
They know they can increase their premiums and people are going to cough up the dough.

That makes me sick.