Obamacare faces Supreme Court Challenge

[cupper]

To get the discussion back on track:

I think the most pressing question is: does the government have the authority to tell the populace how and where to spend their money?

I say no. Others contend that the greater good trumps individual rights. Personally I think the most fundamental change to health care in the US should be tort reform. But that would require the lawyers who occupy the house and senate to agree... and how likely is that?

Tort reform has been shown to have only a minimal effect on overall health care costs. the CBO estimated that it would reduce the overall costs by about 0.5%

http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/106xx/doc10641/10-09-tort_reform.pdf

A more realistic fundamental change should be moving to a federally regulated single payer system. It addresses many of the complaints on both sides. It provides for cost controls by limiting the pay outs. It reduces or eliminates the inherent administrative costs that exist in the current insurance based system. It eliminates the issues of coverage, portability and affordability. It would also allow the Federal Government to negotiate directly with the drug companies for pricing under Medicare and Medicaid.

Like I said previously, Obamacare (which, by the way the Dems are now using as a rallying cry rather than a derogatory reference) tries to do too much too soon, but missed the opportunity to resolve the biggest issues by going single payer.

And that is the fault of the Dems. They dismissed GOP efforts to amend the bill, opting to go it alone rather than work to get a lesser bill passed with bipartisan support. And here we are today speculating the outcome of the Supreme Court deliberations.

 

[Brad Sallows]

If Prop 8 was overturned for being unconstitutional, it doesn't look like judicial activism.  There may be dispute as to its constitutionality, but the entire point of the court system is to resolve disputes.

The Democrats were too chickensh!t to raise the necessary taxes, so the individual mandate was born.

 

[tomahawk6]

The individual mandate is a funding mechanism.It is also the gateway to everyone being added to medicare or medicaid,depending on age.

 

[cupper]

If Prop 8 was overturned for being unconstitutional, it doesn't look like judicial activism.

If it doesn't look like judicial activism, why is the right whining that it is?

 

[a_majoor]

A more realistic fundamental change should be moving to a federally regulated single payer system. It addresses many of the complaints on both sides. It provides for cost controls by limiting the pay outs. It reduces or eliminates the inherent administrative costs that exist in the current insurance based system. It eliminates the issues of coverage, portability and affordability. It would also allow the Federal Government to negotiate directly with the drug companies for pricing under Medicare and Medicaid.

Given the rather alarming problems inherent in our "single payer system" (long wait times, lack of modern technology such as MRI and PET machines, drug shortages [exacerbated by bulk buys discouraging alternative vendors from going into the market], dirty hospitals, etc.) I would not advocate for that at all.

I have personal knowledge of this as well, my mother in law waited nearly a year just to see a specialist for joint replacement surgury (she is still waiting for the surgury date after the consulootation) and I have sat in an emergency room waiting room for hours with my daughter while she had a severe asthma attack. I'm pretty sure lots of other Army.ca members can attest to various horror stories as well.

The primary flaw in single payer is there is no visible connection between the patient and the provider, which eliminates most forms of incentive both ways. Patients can demand anything since they don't have to pay for it directly, while providers have few incentives to actually provide care; most health care funding in Canada seems to be eaten up by bureaucracy. How else can you explain the reletively static outcomes despite literally billions of dollars poured into "healthcare" over the years?

 

[Edward Campbell]

By its very nature any single payer system means rationing. It violates an individual's right to use his private property (his money) for his own benefit.

Most European countries, especially the ones that have better medical outcomes and spend a lesser share of GDP on healthcare than does Canada, have mixed system: universal public insurance covers everyone for most medically necessary services, but rationing is the (only available) tool to control supply in the face of essentially infinite demand; private insurance (or just gobs of cash for the super-rich) allows many (most?) Europeans to jump the public queue.

The very worst model for America is Canada; the very worst model for Canada is America. Europe offers some good models for both Canada and the USA; Singapore offers an excellent model for Canada but it is probably too public[/u] for American tastes.

 

[Brad Sallows]

"Single-payer" does not have to mean "single-payer for everything" or "exclusive payer".

>If it doesn't look like judicial activism, why is the right whining that it is?

Because to a lot of folks, "judicial activism" = "I don't agree with/approve of the decision".  There is a thread discussing variations of what "judicial activism" means [at volokh.com].  It has become so widely interpreted in meaning that it is almost useless except as a pejorative like "facism" or "racist".  But of all the meanings, "I don't like the result" is simply banal.

[a link to the discussion would help]

 

[cupper]

Would you rather fight with your insurance company over the fact that the emergency room visit was not an emergency and therefore they won't cover it? Of have to submit several requests to get a medication that your doctor has prescribed, because you insurance company has a policy of denying initial requests hoping that you won't appeal it. Or have your insurance company deny your request because their medical reviewer says you don't meet any of the requirements for said prescription, even though your doctor has provided back-up that you do meet a sufficient number of those same requirements?

Having spent my first 36 years in the Canadian system, and the last 10 in the US system, I've seen both the good and the bad of both. The ideal is a single payer system, where the patient is partly responsible by either co-pays or paying a portion of the bill.

 

[cupper]

"Single-payer" does not have to mean "single-payer for everything" or "exclusive payer".

>If it doesn't look like judicial activism, why is the right whining that it is?

Because to a lot of folks, "judicial activism" = "I don't agree with/approve of the decision".  There is a thread discussing variations of what "judicial activism" means.  It has become so widely interpreted in meaning that it is almost useless except as a pejorative like "facism" or "racist".  But of all the meanings, "I don't like the result" is simply banal.

I agree with you whole heartedly.    There must be something wrong. :dunno:

 

[a_majoor]

Having spent my first 36 years in the Canadian system, and the last 10 in the US system, I've seen both the good and the bad of both. The ideal is a single payer system, where the patient is partly responsible by either co-pays or paying a portion of the bill.

Well now we have more than one payer  :nod:

Actually cupper, you have the essential outline of what I would see as a better way; the patient does pay for basic services (ideally through withdrawls from a Registered Medical Savings Plan, similar in concept to an RRSP). Since the patient funds the RMSP themselves, they have incentives to keep the outflows to a minimum, which include living a healthy lifestyle, shopping for the lowest cost products and services and so on. The accumulated MRSP continues to grow, so if you start young you will ideally have a large enough nest egg to pay for your medical needs as you reach your years of declining health.

A free insurance market (eliminating the notions that your coverage is tied to your employer or you are limited to purchasing insurance from a small number of suppliers in your own state) would handle more intricate needs (much of the abuse of insurance may be tied to gaming the system, especially if they can get Medicare or Medicaid to pay vs the shareholders), and finally a layer of catastrophe coverage, which may or may not be government funded.

Eliminating the monster bureaucracy would mean the "capture" of taxpayer health care dollars would no longer take place, market forces would operate in a meaningful fashion and patients and providers would have positive incentives to change their behaviour.

 

[cupper]

Well now we have more than one payer  :nod:

Actually cupper, you have the essential outline of what I would see as a better way; the patient does pay for basic services (ideally through withdrawls from a Registered Medical Savings Plan, similar in concept to an RRSP). Since the patient funds the RMSP themselves, they have incentives to keep the outflows to a minimum, which include living a healthy lifestyle, shopping for the lowest cost products and services and so on. The accumulated MRSP continues to grow, so if you start young you will ideally have a large enough nest egg to pay for your medical needs as you reach your years of declining health.

A free insurance market (eliminating the notions that your coverage is tied to your employer or you are limited to purchasing insurance from a small number of suppliers in your own state) would handle more intricate needs (much of the abuse of insurance may be tied to gaming the system, especially if they can get Medicare or Medicaid to pay vs the shareholders), and finally a layer of catastrophe coverage, which may or may not be government funded.

Eliminating the monster bureaucracy would mean the "capture" of taxpayer health care dollars would no longer take place, market forces would operate in a meaningful fashion and patients and providers would have positive incentives to change their behaviour.

They already have medical savings plans in the US. They way they work depends on the type you have. (I won't bore you all with the in's and out's)

I don't agree with having an insurance market. The incentives for the insurance companies are to make a return for shareholders, not provide services to the consumer. Thus you are back to the current system in place. And having multiple insurance companies providing the same services creates huge administrative costs for health care providers. When I refer to a 'Single Payer' system, I'm essentially calling for the government to be the insurance company, eliminating private insurance involvement completely. I am in favor of user fees which are banned in Canada.

People need to remember that health care is not like buying other commercial products. You don't always have the ability to shop around, and the majority of patients really are not capable of understanding the intricacies (@#$% Boston!  :tempertantrum: ) of medical treatments, and what is necessary, what is not, what has a better outcome, and what is the most cost effective path. And when it is a definite emergency situation, you don't have time.

What is interesting is that when you ask people down here what they want for a system, they describe an ideal where they don't need to deal with insurance, but are still willing to pay for some portion of their health care costs. When you ask if they would be willing to pay a tax for that type of healthcare, they say no way, we're taxed too much as it is. But when you tell them that the tax would be equal to or less than what they pay for insurance, they are more receptive to the idea.

 

[a_majoor]

You benefit from a market in every other kind of good and service you seek out, and all market participants are out for their own good (either maximizing shareholder value, increasing profit or paying the lowest price). There is no particular reason to suspect that insurance companies like Kaiser Permanente is any less aggressive in its market and shareholder activities than Ford, Boeing or the guy who weeded your lawn. This is hardly a new idea, Adam Smith first codified it in "The Wealth of Nations".

In fact, a large pool of competing insurance providers would have less bureaucratic overhead than Medicare or Medicaid  or insurance companies today for the simple reason that administrative costs would eat into profit and shareholder value. If a shakeout ends up with one or two monolithic providers (like an insurance version of Google.com), then the lack of competition would be the actual reason for poor customer service and growing "overhead", and legislation would need to be drafted to make entry into the market fairly simple in order to maintain a pool of competetors.

Now there is another issue which hasn't been addressed here (and probably should be taken to another thread anyway), which is the role of the regulatory system in driving up costs. How much overhead do doctors, clinics, hospitals and insurance companies need to deal with the regulatory aspects of dealing with the government? One of the chief arguments against Obamacare outside of the constitutional arguments in the Supreme Court is it would rapidly drive up costs due to increasingly complex regulatory measures (and indeed, many people who currently have health coverage would find themselves dropped under Obamacare as business and insurance companies pushed them into Medicare or Medicaid to control their own costs).