Obama wins.

SDN Members don't see this ad. (About Ads)

Not to hijack the thread but do you guys think that the projected cuts to physician reimbursement will deter some people from applying to medical school?

I love how everyone is quick to share their thoughts and opinions but fail to even READ the Court's opinion before doing so. Talk about armchair legislating.

Originally Posted by bjams12

Not to hijack the thread but do you guys think that the projected cuts to physician reimbursement will deter some people from applying to medical school?

I doubt for this cycle. People who've gotten past all the prereqs/MCAT/shadowing/volunteering/ECs aren't going to quit now. But if you're talking about the future, decreased compensation and the 2015 MCAT may deter quite a few, so maybe there will be a decline.

Originally Posted by NickNaylor

I love how everyone is quick to share their thoughts and opinions but fail to even READ the Court's opinion before doing so. Talk about armchair legislating.

I downloaded the pdf, saw it was 193 pages and fell asleep. I'll wait for a summary from a reputable news source before passing judgement

Originally Posted by NickNaylor

I love how everyone is quick to share their thoughts and opinions but fail to even READ the Court's opinion before doing so. Talk about armchair legislating.

If you were actually reading it, you wouldn't be posting, since I doubt you're a Constitutional scholar bright enough to understand everything being said in under 40 minutes.

I know it's being held up as a tax, which was the third argument that the government used to defend the law, and that the language referring to it as a "penalty" is thus incorrect. The argument was that the law is constitutionally allowed but that its wisdom should be left to the legislature. States will not lose their existing Medicaid funding should they decide not to expand Medicaid as the law allows. Seven justices believe that said portion was an overreaching of Congress' ability.

The dissent considered this law invalid in whole, in part because it's a massive disaster full of earmarks and odd particulars.

Get it close enough?

Edit: As predicted, Roberts' opinion was just about the constitutionality and not, as far as I could tell, about the social effects. Roberts' opinion opened with a description of the relevant acts and why the first two arguments were struck down, then the reasons as to why this can work as a tax.

Originally Posted by TexasPhysician

The mandate increases Medicare. Docs are cutting out Medicare from their practice. Only public hospitals and ERs will see these patients. Costs will rise - increasing taxes to float Medicare. ER wait times will go up. Staff at public facilities will need huge expansion or quality of care will diminish.

A fellow neurologist announced closing his outpatient geriatric clinic today due to suffering reimbursements. His practice was largely government healthcare and now these patients have nowhere to go. He is moving to a private hospital - more money for less work.

I think you meant Medicaid, however, te court ruled that states will not be forced to expand Medicaid (read the NYTimes). If Meicaid were expanded, I'd agree with you, but fortunately, the court struck this part down

Originally Posted by SoulinNeed

Thank God the individual mandate was upheld. People need to realize that reimbursement cuts are coming anyway, with or without Obamacare. At least with the individual mandate it will mean more people will be on private insurance to help overcome some of those cuts. Without the mandate, it would just mean future cuts with nothing to show for it, and it would also really make the current expansion of med schools really silly.

No, thank the Supreme Court.

Originally Posted by NickNaylor

I love how everyone is quick to share their thoughts and opinions but fail to even READ the Court's opinion before doing so. Talk about armchair legislating.

well this is pre-medical, not pre-law

Originally Posted by Brachyury

I think you meant Medicaid, however, te court ruled that states will not be forced to expand Medicaid (read the NYTimes). If Meicaid were expanded, I'd agree with you, but fortunately, the court struck this part down

It didn't strike it down. It said that states could not lose their existing funding if they declined to expand Medicaid to include, among other people, able-bodied people below 133% of the federal poverty level. The law originally said that states could either expand coverage and retain their Medicaid funding or decline to expand coverage...and lose their Medicaid funding altogether. Seven out of nine justices felt this was beyond Congress' power.

This means that poor people in the red states will still have jack for coverage because it's unlikely that a state like, say, Tennessee will voluntarily expand Medicaid.

Originally Posted by TexasPhysician

Maybe you should understand the mandate and it's consequences first.

Nice try. The immature liberal militia in the premed forum has no grasp of logic or common sense. Healthcare/access will not change. But we can all look forward to increasing costs/premiums, lower reimbursements and higher federal taxes to support the incoming army/department of hapless federal beaurocrats that will be chasing down and harassing law abiding citizens about their personal health care decisions. Maybe we can also arrest and strap down 55 year-old men who are not screened yet and force colonoscopes up their shoot against their wishes. Curious George's next communist initiate will be to solve homelessness by making a mandate all people prove to big brother/uncle sam they have a mortgage or else have their shopping carts and aluminum cans confiscated.

Originally Posted by BrainOnFire

The problem is that the health care law is wildly unpopular, with only 34% approval rating.

The approval rating bothers me because most people have no idea what is even in the law, they are just against it because someone else is... People in our country need to care enough to see what the components of proposed laws are rather than simply jumping on the bandwagon

Merged all threads regarding the Supreme Court Ruling. Please use this thread and do not start a new one.

Originally Posted by dmf2682

I downloaded the pdf, saw it was 193 pages and fell asleep. I'll wait for a summary from a reputable news source before passing judgement

Originally Posted by Kunu

Nice try. The immature liberal militia in the premed forum has no grasp of logic or common sense. Healthcare/access will not change. But we can all look forward to increasing costs/premiums, lower reimbursements and higher federal taxes to support the incoming army/department of hapless federal beaurocrats that will be chasing down and harassing law abiding citizens about their personal health care decisions. Maybe we can also arrest and strap down 55 year-old men who are not screened yet and force colonoscopes up their shoot against their wishes. Curious George's next communist initiate will be to solve homelessness by making a mandate all people prove to big brother/uncle sam they have a mortgage or else have their shopping carts and aluminum cans confiscated.

I hope this doesn't derail the thread, as we were having an actually good discussion about the consequences. Please, people, ignore this nonsense.

Originally Posted by PreMedOrDead

CNN said the mandate was cut and my FB exploded. 20 mins later they said it was a mistake.

Originally Posted by Kunu

Nice try. The immature liberal militia in the premed forum has no grasp of logic or common sense. Healthcare/access will not change. But we can all look forward to increasing costs/premiums, lower reimbursements and higher federal taxes to support the incoming army/department of hapless federal beaurocrats that will be chasing down and harassing law abiding citizens about their personal health care decisions. Maybe we can also arrest and strap down 55 year-old men who are not screened yet and force colonoscopes up their shoot against their wishes. Curious George's next communist initiate will be to solve homelessness by making a mandate all people prove to big brother/uncle sam they have a mortgage or else have their shopping carts and aluminum cans confiscated.

Good thing we have someone as mature and rational asyou to set us straight.

Originally Posted by Kunu

Nice try. The immature liberal militia in the premed forum has no grasp of logic or common sense. Healthcare/access will not change. But we can all look forward to increasing costs/premiums, lower reimbursements and higher federal taxes to support the incoming army/department of hapless federal beaurocrats that will be chasing down and harassing law abiding citizens about their personal health care decisions. Maybe we can also arrest and strap down 55 year-old men who are not screened yet and force colonoscopes up their shoot against their wishes. Curious George's next communist initiate will be to solve homelessness by making a mandate all people prove to big brother/uncle sam they have a mortgage or else have their shopping carts and aluminum cans confiscated.

In MA, we prove that we have insurance by getting a document from our insurance companies, which we then staple to our tax documents. If we don't have those forms, we can either explain that we're too poor (in which case, we can either get state health care or just be exempt) or pay a tax. Boom.

So the TONS AND TONS of bureaucrats are probably an extra few guys on tax days with another box to check off. Most of the extra work will be on the insurance company and personal side.

And meanwhile, the republicans are so excited to shove large, pulsing, glowing objects into the orifices of women getting a legal abortion. At least the colonoscopy as a purpose.

Did I not just tell you people to ignore Kunu's post? It's an obvious troll job, and it will ruin a perfectly good discussion. Ignore it, lol.

Originally Posted by BrainOnFire

If you were actually reading it, you wouldn't be posting, since I doubt you're a Constitutional scholar bright enough to understand everything being said in under 40 minutes.

I know it's being held up as a tax, which was the third argument that the government used to defend the law, and that the language referring to it as a "penalty" is thus incorrect. The argument was that the law is constitutionally allowed but that its wisdom should be left to the legislature. States will not lose their existing Medicaid funding should they decide not to expand Medicaid as the law allows. Seven justices believe that said portion was an overreaching of Congress' ability.

The dissent considered this law invalid in whole, in part because it's a massive disaster full of earmarks and odd particulars.

Get it close enough?

Edit: As predicted, Roberts' opinion was just about the constitutionality and not, as far as I could tell, about the social effects. Roberts' opinion opened with a description of the relevant acts and why the first two arguments were struck down, then the reasons as to why this can work as a tax.

This isn't directed at you, so much as something I see often from many people.

So why open our mouths about stuff we don't understand? People have all kinds of views about the way things should/shouldn't work and what's right/wrong when they don't even know what they're talking about. That doesn't stop them from spreading their message all over God's creation. In the same way I expect someone not trained in medicine/biosciences to let people who have devoted their lives to studying and understanding it to back off, I wish the same would occur in other realms as well. Unfortunately, everyone thinks they're an expert and have no qualms pretending they're one, bristling at the slightest suggestion that they may be wrong.

Originally Posted by Narmerguy

This isn't directed at you, so much as something I see often from many people.

So why open our mouths about stuff we don't understand? People have all kinds of views about the way things should/shouldn't work and what's right/wrong when they don't even know what they're talking about. That doesn't stop them from spreading their message all over God's creation. In the same way I expect someone not trained in medicine/biosciences to let people who have devoted their lives to studying and understanding it to back off, I wish the same would occur in other realms as well. Unfortunately, everyone thinks they're an expert and have no qualms pretending they're one, bristling at the slightest suggestion that they may be wrong.

I don't think anyone, especially in the pre-med forums, is an "expert" but we do like discussions, however heated they may get sometimes.

I have two questions:

why is there no incentive for being healthy? I've literally donated about $30000 to health insurance payments in the past few years yet have not been able to use it. If I wanted to go for a "free physical," I still need to pay the full co-pay. That's not part of the problem, just wondering about incentives. Is there anything about that in this health care reform?

And a second question...
was the part where everyone needs to have healthcare being examined as being constitutional?

Originally Posted by Narmerguy

This isn't directed at you, so much as something I see often from many people.

So why open our mouths about stuff we don't understand? People have all kinds of views about the way things should/shouldn't work and what's right/wrong when they don't even know what they're talking about. That doesn't stop them from spreading their message all over God's creation. In the same way I expect someone not trained in medicine/biosciences to let people who have devoted their lives to studying and understanding it to back off, I wish the same would occur in other realms as well. Unfortunately, everyone thinks they're an expert and have no qualms pretending they're one, bristling at the slightest suggestion that they may be wrong.

Because here in America, a strong opinion is valued more than a well-informed one.

Originally Posted by BrainOnFire

If you were actually reading it, you wouldn't be posting, since I doubt you're a Constitutional scholar bright enough to understand everything being said in under 40 minutes.

I know it's being held up as a tax, which was the third argument that the government used to defend the law, and that the language referring to it as a "penalty" is thus incorrect. The argument was that the law is constitutionally allowed but that its wisdom should be left to the legislature. States will not lose their existing Medicaid funding should they decide not to expand Medicaid as the law allows. Seven justices believe that said portion was an overreaching of Congress' ability.

The dissent considered this law invalid in whole, in part because it's a massive disaster full of earmarks and odd particulars.

Get it close enough?

Edit: As predicted, Roberts' opinion was just about the constitutionality and not, as far as I could tell, about the social effects. Roberts' opinion opened with a description of the relevant acts and why the first two arguments were struck down, then the reasons as to why this can work as a tax.

I've gotten through about half of Roberts' opinion and half of the dissent. No, I'm not a legal scholar, but I do make an attempt to read the opinion myself rather than have it spoon-fed to me by a "reputable news source."

(sent from my phone - please forgive typos)

Originally Posted by NickNaylor

I've gotten through about half of Roberts' opinion and half of the dissent. No, I'm not a legal scholar, but I do make an attempt to read the opinion myself rather than have it spoon-fed to me by a "reputable news source."

(sent from my phone - please forgive typos)

I see what you're saying, but if being able to "understand" something requires reading a nearly 200 page report written in dense legal jargon, then something's wrong. If we want people to make informed decisions about issues such as this, then we need to make information accessible to them -- not shame them for being unable to understand what only a tiny proportion of the American population has actually been formally trained to understand.

Originally Posted by jjesque

I see what you're saying, but if being able to "understand" something requires reading a nearly 200 page report written in dense legal jargon, then something's wrong. If we want people to make informed decisions about issues such as this, then we need to make information accessible to them -- not shame them for being unable to understand what only a tiny proportion of the American population has actually been formally trained to understand.

http://www.scotusblog.com/2012/06/th...plain-english/

Originally Posted by jjesque

I see what you're saying, but if being able to "understand" something requires reading a nearly 200 page report written in dense legal jargon, then something's wrong. If we want people to make informed decisions about issues such as this, then we need to make information accessible to them -- not shame them for being unable to understand what only a tiny proportion of the American population has actually been formally trained to understand.

Have you ever read a Supreme Court opinion? They're very accessible and understandable for lay people. If you have a very basic understanding of the Constitution and can read "hard" words, then you can understand the opinion. By the way, each "page" has very wide margins. I imagine a layman could read this opinion in no more than an hour or two. Sure, you're not going to pick up on every little intricacy, but you'll at least get the basic point.

(sent from my phone - please forgive typos)

Originally Posted by NickNaylor

I've gotten through about half of Roberts' opinion and half of the dissent. No, I'm not a legal scholar, but I do make an attempt to read the opinion myself rather than have it spoon-fed to me by a "reputable news source."

(sent from my phone - please forgive typos)

Spoon fed my ass. I know what I'm capable of and reading a 200 page legal document is not part of it. If you can figure out what they're saying in that document good for you but you don't have to belittle the folks who know that they can't.

Originally Posted by TexasPhysician

The mandate increases Medicare. Docs are cutting out Medicare from their practice. Only public hospitals and ERs will see these patients. Costs will rise - increasing taxes to float Medicare. ER wait times will go up. Staff at public facilities will need huge expansion or quality of care will diminish.

A fellow neurologist announced closing his outpatient geriatric clinic today due to suffering reimbursements. His practice was largely government healthcare and now these patients have nowhere to go. He is moving to a private hospital - more money for less work.

He put this in the allo forum too. I think he's pretty confused about what's actually happening here. Docs are for the most part not cutting Medicare from their practice as it's the largest single payer in the entire country. Cutting Medicare from your practice means you don't have much of a practice anymore for many people. Yes they'll get absorbed into hospitals but that trend was already happening. Medicare reimbursement cuts have also been coming for years, we just kept putting them off and living the good life. The ACA just finally puts some of those cuts into place.

Medicaid wise, if you read the majority opinion the Medicaid expansion will most likely NOT occur as the court has deemed federal coercement of the states to expand Medicaid at their own cost in not allowed. I doubt many of these states will expand Medicaid eligibility by themselves.

NOTE: I started writing when this when there were about six responses to the original post. By the time I publish it, I am sure more will have been posted that I did not address.

The court ruled 5-4 that Congress acted within its power when it required Americans to have health insurance, finding Congress could impose the mandate under its authority to levy taxes.

“This is sufficient to sustain it,” ruled Roberts, one of the court’s most conservative justices. “It is not our role to forbid it or to pass upon its wisdom or its fairness.”

- Supreme Court Upholds Obamacare, Christine McConville, Boston Herald

Before commenting further, I wanted to take a moment to highlight this quote from Chief Justice John Roberts who, for those who may not know, is one of the court's most conservative justices; in this ruling, he also unexpectedly served as the swing vote that was necessary for the mandate to be upheld. I wanted to highlight it as, no matter the views that one holds concerning this decision, this quote, this vote, shows an immense amount of integrity that is not often witnessed from either side of the political spectrum, especially within the halls of the Supreme Court. He voted based solely upon the content of and his interpretation of the Constitution's [and further ruling's] declarations on what power Congress does and does not hold. In a post-Bush v Gore Supreme Court, where many of the rulings that have been made over the past few years have seemed overly political, I think this is a refreshing change and is one that should be considered deserving of much respect.

In terms of the mandate itself, from a legal perspective, I am inclined to point out what Justice Roberts has, in that I cannot see how Congress acted in such a way that was beyond their scope of power and, thus, cannot see how the mandate is deserving of being ruled unconstitutional, which is fairly serious accusation separate from claims of detrimental effect or unfairness. To that, I know that many attempt to make the argument that that the mandate is not a tax; but a requirement to purchase a product, which interferes with personal liberty. To that, though, it is important to note that Congress has not mandated that American's purchase insurance, per se; but have mandated that those who do not carry insurance pay a fee, which would be considered a tax and, as such, constitutional. Though that latter point may seem to be semantics, the distinction is an important one, as it outlines a thin line between what is constitutional and what could be ruled unconstitutional.

That last point is an important one to focus on: it is not the Supreme Court's job to rule on if the mandate is fair, popular, detrimental, helpful, good, bad, liberal, conservative, blue, red or any other such descriptor. Their only job, their only ability, is to rule something to be constitutional or unconstitutional. Thus, the discussion on if this ruling was the correct one is an entirely different discussion to if the mandate is a good thing. As this thread progresses, we need to remember that.

All of that being said, in reference to the latter conversation, I have mixed feelings on the mandate and, ultimately, the PPACA itself. It is certainly far from being perfect or ideal, though it also has many extremely positive points that are worth protecting.

Within the law itself, the likes of quality-based reimbursements concerns me, as, though the idea is fantastic in theory, it runs up against the realities of practice. For example, if one is going to base reimbursement on outcome, how do you avoid the fact that, no matter how skilled one is, the physician practicing in an upper class neighborhood is going to have better outcomes than the one practicing in the inner city? Socioeconomic disparity would come into play in a significant way. If they were to base it upon patient satisfaction, how do you protect against the malingering addicts who are bitter about not getting their fifth prescription for painkillers or how do you take into account that quality of care does not always line up with a physician's bedside manner [which patients are likely going to base their ratings off of]? And, as someone who is on Medicaid and has faced the epidemic of physicians turning patients with government-based health care away [though, at least in my sector of the country, it is not quite so bad that only county hospitals will see me], lowering reimbursements concerns me. In that realm, we need to be taking the opposite action -- we need to be raising them or, a least, we need to stop cutting them. In addition, there are a few provisions in the law that, due to their goal of practicing "targeted funding", cause me to feel concerned that a bureaucratic agency is going to take the role of determining which treatments are worth funding, interfering with a physician's ability to treat patients based upon their own medical judgment.

On the flip side, there are numerous measures in this law that are, overall, very positive. For one example, allowing those with preexisting conditions to receive insurance is a much needed change that I eagerly await to take effect. As someone who is chronically ill and, as such, has interacted with many others who face similar difficulties, I have seen the devastation that those denials can cause. In addition, the Children's Insurance Program [CHP], a reduced-cost insurance program for low-income children who do not qualify for Medicaid, will receive more funding. This insurance program is the only reason that many children have insurance. I also consider the affordable insurance exchanges, including the ability to use employer funds to purchase insurance that is more affordable than the one the company allows, to be a progressive and positive step forward for those who have employers who do not cover or who undercover insurance; in particular, I think of those in similar situations that my mom was, who may now be able to afford better prescription coverage than what exists under their employee health insurance. More health care-related tax credits will also be given out to both the middle class employee and small business owner. And, as we were speaking about reimbursement, primary care physicians will expirence higher Medicaid reimbursements, which will hopefully allow them to see more of such patients. Among others, such as the removal of lifetime insurance caps, which severely negatively impacts those with chronic or complex health conditions.

As for the mandate itself, I understand why it is unpopular. Nobody likes feeling as if they are being told what to do and having their freedom of choice interfered with, especially when it involves high financial cost. That said, when someone makes the choice, despite being able to afford it, to not carry health insurance and they then become sick, injured or disabled, other people pay for it. In that sense, the uninsured person is choosing to interfere with another person's choice. The fine imposed upon the uninsured is simply forcing that person to take responsibility for their own healthcare. At the end of the day, if it is fair or unfair, helpful or harmful, I can see what the mandate is attempting to do and that is balance two groups' liberty and choice. That said, I honestly do not hold a strong enough opinion on it at this point in time to want to fight to oppose or defend it.

Originally Posted by Kunu

Nice try. The immature liberal militia in the premed forum has no grasp of logic or common sense. Healthcare/access will not change. But we can all look forward to increasing costs/premiums, lower reimbursements and higher federal taxes to support the incoming army/department of hapless federal beaurocrats that will be chasing down and harassing law abiding citizens about their personal health care decisions. Maybe we can also arrest and strap down 55 year-old men who are not screened yet and force colonoscopes up their shoot against their wishes. Curious George's next communist initiate will be to solve homelessness by making a mandate all people prove to big brother/uncle sam they have a mortgage or else have their shopping carts and aluminum cans confiscated.

yea everything you describe is super logical and common sense too

Originally Posted by dmf2682

Spoon fed my ass. I know what I'm capable of and reading a 200 page legal document is not part of it. If you can figure out what they're saying in that document good for you but you don't have to belittle the folks who know that they can't.

Again, have you TRIED? I'm not "belittling" anyone. I'm simply pointing out that spouting off strong opinions as if you're knowledgeable (as many people in this thread are doing - I don't mean "you're" as in you specifically) without even looking at what the Court said is stupid. If you're not capable of reading it, fine - don't read it. Wait for the analysis and commentary (which will certainly be very good). However I would be surprised if a SCOTUS opinion (especially this one) is beyond the grasp of anyone trying to go to medical school with some Google/Wikipedia help.

Originally Posted by Starlightembers

NOTE: I started writing when this when there were about six responses to the original post. By the time I publish it, I am sure more will have been posted that I did not address.

Before commenting further, I wanted to take a moment to highlight this quote from Chief Justice John Roberts who, for those who may not know, is one of the court's most conservative justices; in this ruling, he also unexpectedly served as the swing vote that was necessary for the mandate to be upheld. I wanted to highlight it as, no matter the views that one holds concerning this decision, this quote, this vote, shows an immense amount of integrity that is not often witnessed from either side of the political spectrum, especially within the halls of the Supreme Court. He voted based solely upon the content of and his interpretation of the Constitution's [and further ruling's] declarations on what power Congress does and does not hold. In a post-Bush v Gore Supreme Court, where many of the rulings that have been made over the past few years have seemed overly political, I think this is a refreshing change and is one that should be considered deserving of much respect.

In terms of the mandate itself, from a legal perspective, I am inclined to point out what Justice Roberts has, in that I cannot see how Congress acted in such a way that was beyond their scope of power and, thus, cannot see how the mandate is deserving of being ruled unconstitutional, which is fairly serious accusation separate from claims of detrimental effect or unfairness. To that, I know that many attempt to make the argument that that the mandate is not a tax; but a requirement to purchase a product, which interferes with personal liberty. To that, though, it is important to note that Congress has not mandated that American's purchase insurance, per se; but have mandated that those who do not carry insurance pay a fee, which would be considered a tax and, as such, constitutional. Though that latter point may seem to be semantics, the distinction is an important one, as it outlines a thin line between what is constitutional and what could be ruled unconstitutional.

That last point is an important one to focus on: it is not the Supreme Court's job to rule on if the mandate is fair, popular, detrimental, helpful, good, bad, liberal, conservative, blue, red or any other such descriptor. Their only job, their only ability, is to rule something to be constitutional or unconstitutional. Thus, the discussion on if this ruling was the correct one is an entirely different discussion to if the mandate is a good thing. As this thread progresses, we need to remember that.

All of that being said, in reference to the latter conversation, I have mixed feelings on the mandate and, ultimately, the PPACA itself. It is certainly far from being perfect or ideal, though it also has many extremely positive points that are worth protecting.

Within the law itself, the likes of quality-based reimbursements concerns me, as, though the idea is fantastic in theory, it runs up against the realities of practice. For example, if one is going to base reimbursement on outcome, how do you avoid the fact that, no matter how skilled one is, the physician practicing in an upper class neighborhood is going to have better outcomes than the one practicing in the inner city? Socioeconomic disparity would come into play in a significant way. If they were to base it upon patient satisfaction, how do you protect against the malingering addicts who are bitter about not getting their fifth prescription for painkillers or how do you take into account that quality of care does not always line up with a physician's bedside manner [which patients are likely going to base their ratings off of]? And, as someone who is on Medicaid and has faced the epidemic of physicians turning patients with government-based health care away [though, at least in my sector of the country, it is not quite so bad that only county hospitals will see me], lowering reimbursements concerns me. In that realm, we need to be taking the opposite action -- we need to be raising them or, a least, we need to stop cutting them. In addition, there are a few provisions in the law that, due to their goal of practicing "targeted funding", cause me to feel concerned that a bureaucratic agency is going to take the role of determining which treatments are worth funding, interfering with a physician's ability to treat patients based upon their own medical judgment.

On the flip side, there are numerous measures in this law that are, overall, very positive. For one example, allowing those with preexisting conditions to receive insurance is a much needed change that I eagerly await to take effect. As someone who is chronically ill and, as such, has interacted with many others who face similar difficulties, I have seen the devastation that those denials can cause. In addition, the Children's Insurance Program [CHP], a reduced-cost insurance program for low-income children who do not qualify for Medicaid, will receive more funding. This insurance program is the only reason that many children have insurance. I also consider the affordable insurance exchanges, including the ability to use employer funds to purchase insurance that is more affordable than the one the company allows, to be a progressive and positive step forward for those who have employers who do not cover or who undercover insurance; in particular, I think of those in similar situations that my mom was, who may now be able to afford better prescription coverage than what exists under their employee health insurance. More health care-related tax credits will also be given out to both the middle class employee and small business owner. And, as we were speaking about reimbursement, primary care physicians will expirence higher Medicaid reimbursements, which will hopefully allow them to see more of such patients. Among others, such as the removal of lifetime insurance caps, which severely negatively impacts those with chronic or complex health conditions.

As for the mandate itself, I understand why it is unpopular. Nobody likes feeling as if they are being told what to do and having their freedom of choice interfered with, especially when it involves high financial cost. That said, when someone makes the choice, despite being able to afford it, to not carry health insurance and they then become sick, injured or disabled, other people pay for it. In that sense, the uninsured person is choosing to interfere with another person's choice. The fine imposed upon the uninsured is simply forcing that person to take responsibility for their own healthcare. At the end of the day, if it is fair or unfair, helpful or harmful, I can see what the mandate is attempting to do and that is balance two groups' liberty and choice. That said, I honestly do not hold a strong enough opinion on it at this point in time to want to fight to oppose or defend it.

Also, here's a more complete quote
From the beginning of the Chief's opinion: "We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation's elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions."

Originally Posted by NickNaylor

Again, have you TRIED?

OK. I tried. I'm man enough to admit that I was wrong and that any college student should be able to read it.

But really. If I had the free time to sit down and read it I would. What's wrong with getting a recap later?

Originally Posted by Starlightembers

Before commenting further, I wanted to take a moment to highlight this quote from Chief Justice John Roberts who, for those who may not know, is one of the court's most conservative justices; in this ruling, he also unexpectedly served as the swing vote that was necessary for the mandate to be upheld. I wanted to highlight it as, no matter the views that one holds concerning this decision, this quote, this vote, shows an immense amount of integrity that is not often witnessed from either side of the political spectrum, especially within the halls of the Supreme Court. He voted based solely upon the content of and his interpretation of the Constitution's [and further ruling's] declarations on what power Congress does and does not hold. In a post-Bush v Gore Supreme Court, where many of the rulings that have been made over the past few years have seemed overly political, I think this is a refreshing change and is one that should be considered deserving of much respect.

I think this is a superficial look at things. Kennedy was the true swing vote; my guess is that Roberts saw how Kennedy was voting and changed his vote to avoid overturning the ACA. Even if overruling the ACA might be what his "principles" tell him to do, politically this would be an absolutely terrible move and would certainly be one of the things the Roberts Court is remembered by - and probably not in a good way. IMO he fudged "his interpretation of the Constitution" to make the law be upheld - not because he thought it was the Constitutionally correct thing to do (according to his legal opinion), but because it was the best thing to do to preserve the SCOTUS' legitimacy.

In terms of the mandate itself, from a legal perspective, I am inclined to point out what Justice Roberts has, in that I cannot see how Congress acted in such a way that was beyond their scope of power and, thus, cannot see how the mandate is deserving of being ruled unconstitutional, which is fairly serious accusation separate from claims of detrimental effect or unfairness. To that, I know that many attempt to make the argument that that the mandate is not a tax; but a requirement to purchase a product, which interferes with personal liberty. To that, though, it is important to note that Congress has not mandated that American's purchase insurance, per se; but have mandated that those who do not carry insurance pay a fee, which would be considered a tax and, as such, constitutional. Though that latter point may seem to be semantics, the distinction is an important one, as it outlines a thin line between what is constitutional and what could be ruled unconstitutional.

You should read the dissent. They do a pretty good job of stating their opinion plainly and explaining why the mandate is dubious at best and illegitimate at worst. Interestingly, Roberts initially says the ACA is NOT a tax (otherwise the Court would not have the ability to hear the case - taxes cannot be challenged in court until they're collected), yet later does a 180 and declares the penalty to in fact be a tax such that it fits within Congress' taxing power and, thus, would be constitutional. This somewhat nonsensical flip flopping is what makes me think that he really struggled to come up with a reasonable argument for upholding the law. This is also brought up in the dissent and held up as somewhat laughable (forgive me for cutting in the middle of a paragraph, but I didn't want to copy everything to give complete context, otherwise it'd be too long):

"The phrase “independently authorized” suggests the existence of a creature never hitherto seen in the United States Reports: A penalty for constitutional purposes that is also a tax for constitutional purposes. In all our cases the two are mutually exclusive. The provision challenged under the Constitution is either a penalty or else a tax. Of course in many cases what was a regulatory mandate enforced by a penalty could have been imposed as a tax upon permissible action; or what was imposed as a tax upon permissible action could have been a regulatory mandate enforced by a penalty. But we know of no case, and the Government cites none, in which the imposition was, for constitutional purposes, both."


That last point is an important one to focus on: it is not the Supreme Court's job to rule on if the mandate is fair, popular, detrimental, helpful, good, bad, liberal, conservative, blue, red or any other such descriptor. Their only job, their only ability, is to rule something to be constitutional or unconstitutional. Thus, the discussion on if this ruling was the correct one is an entirely different discussion to if the mandate is a good thing. As this thread progresses, we need to remember that.

All of that being said, in reference to the latter conversation, I have mixed feelings on the mandate and, ultimately, the PPACA itself. It is certainly far from being perfect or ideal, though it also has many extremely positive points that are worth protecting.

Within the law itself, the likes of quality-based reimbursements concerns me, as, though the idea is fantastic in theory, it runs up against the realities of practice. For example, if one is going to base reimbursement on outcome, how do you avoid the fact that, no matter how skilled one is, the physician practicing in an upper class neighborhood is going to have better outcomes than the one practicing in the inner city? Socioeconomic disparity would come into play in a significant way. If they were to base it upon patient satisfaction, how do you protect against the malingering addicts who are bitter about not getting their fifth prescription for painkillers or how do you take into account that quality of care does not always line up with a physician's bedside manner [which patients are likely going to base their ratings off of]? And, as someone who is on Medicaid and has faced the epidemic of physicians turning patients with government-based health care away [though, at least in my sector of the country, it is not quite so bad that only county hospitals will see me], lowering reimbursements concerns me. In that realm, we need to be taking the opposite action -- we need to be raising them or, a least, we need to stop cutting them. In addition, there are a few provisions in the law that, due to their goal of practicing "targeted funding", cause me to feel concerned that a bureaucratic agency is going to take the role of determining which treatments are worth funding, interfering with a physician's ability to treat patients based upon their own medical judgment.

On the flip side, there are numerous measures in this law that are, overall, very positive. For one example, allowing those with preexisting conditions to receive insurance is a much needed change that I eagerly await to take effect. As someone who is chronically ill and, as such, has interacted with many others who face similar difficulties, I have seen the devastation that those denials can cause. In addition, the Children's Insurance Program [CHP], a reduced-cost insurance program for low-income children who do not qualify for Medicaid, will receive more funding. This insurance program is the only reason that many children have insurance. I also consider the affordable insurance exchanges, including the ability to use employer funds to purchase insurance that is more affordable than the one the company allows, to be a progressive and positive step forward for those who have employers who do not cover or who undercover insurance; in particular, I think of those in similar situations that my mom was, who may now be able to afford better prescription coverage than what exists under their employee health insurance. More health care-related tax credits will also be given out to both the middle class employee and small business owner. And, as we were speaking about reimbursement, primary care physicians will expirence higher Medicaid reimbursements, which will hopefully allow them to see more of such patients. Among others, such as the removal of lifetime insurance caps, which severely negatively impacts those with chronic or complex health conditions.

As for the mandate itself, I understand why it is unpopular. Nobody likes feeling as if they are being told what to do and having their freedom of choice interfered with, especially when it involves high financial cost. That said, when someone makes the choice, despite being able to afford it, to not carry health insurance and they then become sick, injured or disabled, other people pay for it. In that sense, the uninsured person is choosing to interfere with another person's choice. The fine imposed upon the uninsured is simply forcing that person to take responsibility for their own healthcare. At the end of the day, if it is fair or unfair, helpful or harmful, I can see what the mandate is attempting to do and that is balance two groups' liberty and choice. That said, I honestly do not hold a strong enough opinion on it at this point in time to want to fight to oppose or defend it.

My replies are in bold as I didn't want to do multiple quotes.

For those who want to read the opinion, go here: http://www.supremecourt.gov/opinions...s.aspx?Term=11. The case is National Federation of Independent Businesses v Sebelius (3rd one from the top as of this writing).

Originally Posted by Ruminate

I have two questions:

why is there no incentive for being healthy? I've literally donated about $30000 to health insurance payments in the past few years yet have not been able to use it. If I wanted to go for a "free physical," I still need to pay the full co-pay. That's not part of the problem, just wondering about incentives. Is there anything about that in this health care reform?

And a second question...
was the part where everyone needs to have healthcare being examined as being constitutional?

The first part was mentioned during the actual hearing but, as far as I read, wasn't address by Roberts. I am going to guess that the dissent may touch on this point. I will take a look later to see.

The individual mandate was specifically ruled constitutional, as was all of the aca but the Medicaid provision mentioned earlier.

Originally Posted by dmf2682

OK. I tried. I'm man enough to admit that I was wrong and that any college student should be able to read it.

But really. If I had the free time to sit down and read it I would. What's wrong with getting a recap later?

As I said, there's ABSOLUTELY NOTHING wrong with getting a synopsis. My issue is more with Pre-med Joe screaming at the top of his lungs "YEAH OBAMA" or "DAT DER GUBMENT TAKIN MY LIFE" without so much as looking into the issue. If you don't want to read the opinion - I'm cool with that. As long as you're informed, you're fine by my standards. I have a sneaking suspicion, however, that some of the loudest screamers are the least informed (as Narmer mentioned previously) - including on SDN. Their "research" consists of a blog post by Ezra Klein or something from the conservative equivalent - and that's a shame.

Originally Posted by Kmd001

The approval rating bothers me because most people have no idea what is even in the law, they are just against it because someone else is... People in our country need to care enough to see what the components of proposed laws are rather than simply jumping on the bandwagon

This comment enrages me. A 2700-PAGE BILL?! One which NOT ONE member of Congress has read, and you expect everyone to read it before criticizing? It's easy to point out the goodies in the bill. The fact that it costs a ****load of money and will push our country further into recession/depression? Who cares, now we get to feel good about ourselves that "everyone will have access to health insurance." (Note that this does not equate with healthcare - the quality of which will plummet.) The fact that it takes away freedom? Bah, "freedom" is just a word for unsophisticated rubes.

The people who dislike the law are FAR more aware of its contents than those who plod blindly along with a bill passed in the dead of night. This is anything but a Patient Protection and Affordable Care Act. It's a disaster. And it's not going to work.

Originally Posted by NickNaylor

As I said, there's ABSOLUTELY NOTHING wrong with getting a synopsis. My issue is more with Pre-med Joe screaming at the top of his lungs "YEAH OBAMA" or "DAT DER GUBMENT TAKIN MY LIFE" without so much as looking into the issue. If you don't want to read the opinion - I'm cool with that. As long as you're informed, you're fine by my standards. I have a sneaking suspicion, however, that some of the loudest screamers are the least informed (as Narmer mentioned previously) - including on SDN. Their "research" consists of a blog post by Ezra Klein or something from the conservative equivalent - and that's a shame.

https://www.coursera.org/course/healthpolicy

The professor is biased, but you'd be hard pressed to find a lecturer on this issue who isn't. And it's free!

does this mean doctors will be paid less in the future?

Originally Posted by NickNaylor

As I said, there's ABSOLUTELY NOTHING wrong with getting a synopsis. My issue is more with Pre-med Joe screaming at the top of his lungs "YEAH OBAMA" or "DAT DER GUBMENT TAKIN MY LIFE" without so much as looking into the issue. If you don't want to read the opinion - I'm cool with that. As long as you're informed, you're fine by my standards. I have a sneaking suspicion, however, that some of the loudest screamers are the least informed (as Narmer mentioned previously) - including on SDN. Their "research" consists of a blog post by Ezra Klein or something from the conservative equivalent - and that's a shame.

Fair enough. Guess you made an edit while I wrote that response.

Makes you think the preallo board is somewhat representative of the political scene, eh?

It's a good thing the Obama administration can rely upon the SC to do the thinking (and distortion) for them. First, in 2009, Obama says it's not a tax:

https://www.youtube.com/watch?v=Bv9i...layer_embedded

Then he says it is a tax.

I guess it's not considered a flip-flop when the SC decides your latter position is correct?

Hope and Change.

Originally Posted by dmf2682

Fair enough. Guess you made an edit while I wrote that response.

Makes you think the preallo board is somewhat representative of the political scene, eh?

Yes, yes it is - funny how that works.

Originally Posted by Dave89

This comment enrages me. A 2700-PAGE BILL?! One which NOT ONE member of Congress has read, and you expect everyone to read it before criticizing? It's easy to point out the goodies in the bill. The fact that it costs a ****load of money and will push our country further into recession/depression? Who cares, now we get to feel good about ourselves that "everyone will have access to health insurance." (Note that this does not equate with healthcare - the quality of which will plummet.) The fact that it takes away freedom? Bah, "freedom" is just a word for unsophisticated rubes.

The people who dislike the law are FAR more aware of its contents than those who plod blindly along with a bill passed in the dead of night. This is anything but a Patient Protection and Affordable Care Act. It's a disaster. And it's not going to work.

I think this sentence ruins your argument entirely. You claim to be highly aware of the law's objective contents and you distinguish yourself from those who "plod blindly" behind the law, yet you use one of the most overused and meaningless conservative catchphrases out there. Did you hear the part where the individual mandate is constitutional under taxing power? Yes, you are already subject to "loss of freedom" on a daily basis in the form of a variety of federal taxes. And, yes, we all generally agree that taxes as an institution are an acceptable loss of freedom in a civilized society.

Besides, people who believe "freedom" constitutes minimal government intervention in their daily lives seem to me either naive or narrow-sighted. Unless you live in a cabin somewhere on a mountain completely removed from society, you enjoy benefits brought to you by your government every single day.

Originally Posted by NickNaylor

Have you ever read a Supreme Court opinion? They're very accessible and understandable for lay people. If you have a very basic understanding of the Constitution and can read "hard" words, then you can understand the opinion. By the way, each "page" has very wide margins. I imagine a layman could read this opinion in no more than an hour or two. Sure, you're not going to pick up on every little intricacy, but you'll at least get the basic point.

(sent from my phone - please forgive typos)

I don't imagine a "layman" could read and interpret this document at all, much less in an hour or two. But maybe we have very different ideas of what a layman is.

In any case, the original point was that we cannot on one hand mock people for being "uninformed" or "underinformed" while on the other hand maintaining that the only acceptable source of information is the primary source, in this case, the legal document itself. In that type of situation, the lack of public understanding is, in my opinion, the fault of the information providers, not of the public.

Originally Posted by jjesque

I think this sentence ruins your argument entirely. You claim to be highly aware of the law's objective contents and you distinguish yourself from those who "plod blindly" behind the law, yet you use one of the most overused and meaningless conservative catchphrases out there. Did you hear the part where the individual mandate is constitutional under taxing power? Yes, you are already subject to "loss of freedom" on a daily basis in the form of a variety of federal taxes. And, yes, we all generally agree that taxes as an institution are an acceptable loss of freedom in a civilized society.

Besides, people who believe "freedom" constitutes minimal government intervention in their daily lives seem to me either naive or narrow-sighted. Unless you live in a cabin somewhere on a mountain completely removed from society, you enjoy benefits brought to you by your government every single day.

We're not talking about painting pickup trucks with American flags all over them (though I have no problem with those who do). Or "freedom fries." This is a case of government forcing you to buy a product, or imposing a penalty on you for doing so. The SC said it's a tax, and I defer to their judgment. But Obama himself said it's not a tax. I could go on, but if you really think we ought not to have minimal government intervention in our lives, there's really nothing to say to you.

Originally Posted by Dave89

This comment enrages me. A 2700-PAGE BILL?! One which NOT ONE member of Congress has read, and you expect everyone to read it before criticizing? It's easy to point out the goodies in the bill. The fact that it costs a ****load of money and will push our country further into recession/depression? Who cares, now we get to feel good about ourselves that "everyone will have access to health insurance." (Note that this does not equate with healthcare - the quality of which will plummet.) The fact that it takes away freedom? Bah, "freedom" is just a word for unsophisticated rubes.

The people who dislike the law are FAR more aware of its contents than those who plod blindly along with a bill passed in the dead of night. This is anything but a Patient Protection and Affordable Care Act. It's a disaster. And it's not going to work.

Thanks for the lulz!

Originally Posted by diasIItema

I would look at the German system. No single payer, but insurance companies, or sickness funds, are not-for-profit. But there is still incentive that drives competition. This way they're able to keep pharmaceuticals at a low-cost. Also, medical education and overhead is subsidized and there is a large financial bonus to keeping your patient population healthy.

Wait times and quality there is on par with the US, but they end up having higher quality outcomes. On the other hand, doctors there get paid 1/2 of what they would over here.

I don't want to give the impression here that my desire for the dinero is why I want to go into medicine, but am simply echoing the deep concerns shared by doctors right now (or at least the ones I shadowed). I doubt that they would very much like a paycut.

Originally Posted by SpacemanSpifff

I am not sure what a monopsony is, but it sounds downright terrifying!

It's like where a company that's hiring has a "monopoly" on the hiring process. For example, if there was only 1 company in the world that made MEGA-widgets that decided it needed to hire new people, they would have the advantage in setting salaries (ideally as low as possible) for those positions since they don't have to compete with other companies for sources of labor in the MEGA-widgets labor market.

Originally Posted by Dave89

This comment enrages me. A 2700-PAGE BILL?! One which NOT ONE member of Congress has read, and you expect everyone to read it before criticizing? It's easy to point out the goodies in the bill. The fact that it costs a ****load of money and will push our country further into recession/depression? Who cares, now we get to feel good about ourselves that "everyone will have access to health insurance." (Note that this does not equate with healthcare - the quality of which will plummet.) The fact that it takes away freedom? Bah, "freedom" is just a word for unsophisticated rubes.

The same people who dislike the imposition of the health care act are very much in favor of surveying people with drones, wiretapping without warrants, restricting legal medical procedures on religious grounds, and generally acting as if freedom is secondary to protecting the US from a nebulous terrorist threat. Why is it anti-freedom when it involves taking personal responsibility for health but pro-freedom when you legislate against privacy?

Also, I can read a 2700 page bill if I need to. It's not my fault that Congress is lazy.

The people who dislike the law are FAR more aware of its contents than those who plod blindly along with a bill passed in the dead of night. This is anything but a Patient Protection and Affordable Care Act. It's a disaster. And it's not going to work.

I disagree with this statement merely because of the ridiculous fearmongering that has gone along with the debate. The representative who stated that the signed/passed law would put you in jail if you failed to comply directly contrasted the text of the law. All of the people who believe that they're going to be forcibly separated from their doctors, which is why they oppose the bill, are operating under an incorrect set of parameters: if they don't have a doctor, it's not the bill's fault directly or perhaps even indirectly.

But Obama himself said it's not a tax. I could go on, but if you really think we ought not to have minimal government intervention in our lives, there's really nothing to say to you.

Straw man. Politicians often say X and then Y happens; this isn't unique to Obama. Remember that Romney helped health care in MA and generally seemed in favor of gay marriages in the state. Beyond that, though, the government's third argument in front of the Supreme Court was that this was a tax. The administration and its lawyers recognized that if the two original arguments didn't work, they might need to reframe this in terms of a tax. Does it violate the spirit of the original intent? Perhaps. However, it's a legitimate argument.

However, your last statement has zero merit because of the gay marriage debate. Time and again the argument has been used to deny gay marriage because the federal government has an interest in promoting healthy (straight) marriages to benefit children. That's why, in theory, there are so many tax breaks available for the married. If the government can interfere with the administration of taxes and benefits based on sexual status, it can ask people to buy health care. Remember that there are states in which agreements that resemble marriage benefits, such as power of attorney, are specifically forbidden. If you can't see that said act is government interference by the "low interference" party, I don't know what to say to you.

Originally Posted by Dave89

We're not talking about painting pickup trucks with American flags all over them (though I have no problem with those who do). Or "freedom fries." This is a case of government forcing you to buy a product, or imposing a penalty on you for doing so. The SC said it's a tax, and I defer to their judgment. But Obama himself said it's not a tax. I could go on, but if you really think we ought not to have minimal government intervention in our lives, there's really nothing to say to you.

It's semantics. Obama said it isn't a tax because the word "tax" is a curse word to the voting public. But the individual mandate is a tax in the same way that Canadians pay a portion of their income each year to fund public health insurance. And, as I said before, we have taxes for all manners of things and we accept their existence. Why is this different?

As for your last sentence, I don't have any response as you haven't given me anything but blind emotion to respond to. So, in that sense, I guess I also have "nothing to say to you."

.