Affordable Care Act challenged at Supreme Court

[music2doc]

Fundamental question:

Is health care a right or a commodity?

If the government is arguing for this law on the basis of health care being a right, then there should be no reason for the Supreme Court to overturn the ACA. If they have articulated it as a commodity, then I can see them striking parts of the bill down. Unfortunately it seems like it's leaning towards the latter...

And then the million-dollar question:

How does the political left react if this bill cannot be implemented properly?

A push for single-payer would make sense if health care costs cannot be controlled (which they wouldn't be with reform/privatization). But that would require some chutzpah on the part of the Democrats

This is the fundamental question. And while I absolutely believe we should give charitably and that we should do our best to serve those who cannot afford care, I think it is crucial that we realize that healthcare cannot be anything but a privilege, a wish, a desire. To make it a right deprives others of their rights. Period. No way around it.

That said, what makes you think healthcare is a right and not a privilege?

[FONT=Times New Roman, Times, serif]We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are life, liberty and the pursuit of happiness..

So you have the right to live, although natural circumstances may impede this without violating that right (i.e., lightning, drowning, cancer, etc.). You have the right to liberty (i.e., not being required to do things for others, not to be enslaved). And you have the right to pursue happiness.

Those are the basics rights according to the Constitution. Pretty simple, really. The right to life (of a sick person) vs. the right to liberty (of a healthcare provider) comes down to definition. The right to life seems most clearly to mean the right to not be murdered. That is, it is the right to remain alive. It is a passive right (just as the right to liberty) and is a right insofar as it does not impede on another person's rights.

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a grand jury, except in cases arising in the land or naval forces, or in the militia, when in actual service in time of war or public danger; nor shall any person be subject for the same offense to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

To make healthcare a right, we must violate the final two clauses of Amendment V. The problem is that neither Congress nor the US Government has resources of its own. They must take resources from one person to give to another. In the form of taxes that pay for services we all use, we see just compensation (i.e., the Fire Dept serves us all, as does the military) in fairly uniform/equal ways; however, healthcare does not work this way (i.e., 95% of the resources are utilized by 5% of the population). In other words, someone is having wages taken from him/her and given to another in an illegal and unconstitutional manner.

The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.

Amendment X tells us that if the Constitution does not specify a right, the States and/or the People retain that right by default. In other words, the Constitution does not give the Federal Government the authority to take away a right to just compensation from healthcare providers in order to provide free healthcare to people in need.


Even the United Nations agrees (UN Declaration of Human Rights):

Article 2.

• Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

So the fact that someone is more wealthy than another person does not place his or her rights under those of another person who is less wealthy. Unfortunately, this needs to be stated, as it is often an argument people will make -- the fallacy of Robin Hood economics.

Article 3.

• Everyone has the right to life, liberty and security of person.

See above.... This is basically a direct quote from the Declaration.

Article 4.

• No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.

To be forced to provide care for someone who cannot pay is a form of slavery. It is prohibited by the UN.

Article 12.

• No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

This is violated on two levels: 1) a right to healthcare interferes with a healthcare provider's life and family, and 2) through the abuse of malpractice, a "rights" mentality promotes such attacks on the provider's honor and reputation.

Article 17.

• (1) Everyone has the right to own property alone as well as in association with others.
• (2) No one shall be arbitrarily deprived of his property.

A right to healthcare is a direct violation of both parts of this right.

Article 23.

• (1) Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.
• (2) Everyone, without any discrimination, has the right to equal pay for equal work.
• (3) Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.
• (4) Everyone has the right to form and to join trade unions for the protection of his interests.

2) To be paid for one's work is a human right according to the UN. If a client is unable to pay, one can choose to provide work charitably; however, to force any person to do said work for free is a direct violation of this right.

Article 24.

• Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

Funny how that (doesn't) work(s) out for physicians.... Regardless, to require healthcare workers to serve these people would deprive them of this right (due to limited resources and an inability to serve all of those people given the available resources, human or otherwise).

Article 25.

• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
• (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

This could be considered the foundational right for a "right to healthcare;" however, as demonstrated above, this would be in direct violation of other rights. I would argue that a better way to approach these needs is through charitable support for these people.

Article 29.

• (1) Everyone has duties to the community in which alone the free and full development of his personality is possible.
• (2) In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.
• (3) These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.

1) Everyone has duties that must be fulfilled. This could be read as a condition upon which the other rights rely. If one is in violation of those duties, he or she might not enjoy all of these rights as a natural consequence. (E.g., if one does not pay for something, he or she may be forced to pay off the debt through servitude. Is this a violation of his or her rights?)

2) I would read this as basically saying your rights are limited by those of others (i.e., you may not utilize your rights to impinge upon the rights of others).

Article 30.

• Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.

In other words, your rights should not allow you to walk on others' rights. My rights are my rights. Yours are yours. Where they clash, it is the passive aspect of the right that wins out (i.e., the part not requiring its "use"; the part we might called "defensive"). In the case of the right to healthcare, this would mean the freedom of another person (i.e., the healthcare provider).

While I support charity work and intend to do it myself as a large part of my eventual career, I see it as highly unethical to force someone into providing care for another person (free of charge) as it impinges upon the other person's rights.

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[music2doc]

Aren't those the statements that make this forum entertaining? lol...

 

[music2doc]

http://en.wikipedia.org/wiki/Preamble_to_the_United_States_Constitution#Text

Sorry, you're right... wrong document. Long day!

 

[IRASNA]

We're supposed to follow those crazy, ancient rules those old male WASPs wrote up in their fancy handwriting way back when?! Didn't they have slaves and suppress women? And have terrible oral health?
I'd prefer to use contemporary logic and knowledge that I've learned from the K-12 + higher education that I had the right to receive as a productive member of society.

 

[galaxyx]

On the food stamps: Many localities do restrict the purchase of hot food (incl fast food) with food stamps. For example, in Mass you can only get a WIC card for hot food if you're homeless or have some extenuating circumstances that prevent you from cooking your own food.

As far as paying for the healthcare of poor lifestyle choices, the model used in some other countries (i.e. Australia) is to heavily tax the lifestyle items such as cigarettes and alcohol and have the tax pay into the healthcare system. I suppose you could add the tax to candy, etc. if you wanted to be that particular.

 

[deleted393595]

UNDHR Stuff

While I'm all for the UNDHR, most of it is highly aspirational and hard to implement. Maybe in the future, but not today.

 

[Joe the Plumber]

Voluntary sterilization with cash compensation. Think about it.

 

[NickNaylor]

We're supposed to follow those crazy, ancient rules those old male WASPs wrote up in their fancy handwriting way back when?! Didn't they have slaves and suppress women? And have terrible oral health?
I'd prefer to use contemporary logic and knowledge that I've learned from the K-12 + higher education that I had the right to receive as a productive member of society.

...what?

 

[IRASNA]

...what?

That was in response to music2doc's interpretation of the Constitution, Declaration, etc.

Anyways, I can't find a concise summary of how the last day turned out in court (at least not like the "train wreck" description from Tuesday). Anyone know how the judges seem to feel about severability, etc.?

 

[theseeker4]

We're supposed to follow those crazy, ancient rules those old male WASPs wrote up in their fancy handwriting way back when?! Didn't they have slaves and suppress women? And have terrible oral health?
I'd prefer to use contemporary logic and knowledge that I've learned from the K-12 + higher education that I had the right to receive as a productive member of society.

So we should ignore the document that founded the country, reserving rights to protect individuals and states from government overreach? We should allow the government to do anything and everything they want in the name of "contemporary logic," no matter who is deprived of what rights, because you don't like the conclusions the Constitution leads to? Either you are trolling, or you are honestly of the opinion that individual rights enumerated in the Constitution are meaningless and should be discarded. Either way, strong work

 

[ppfizenm]

This is the fundamental question. And while I absolutely believe we should give charitably and that we should do our best to serve those who cannot afford care, I think it is crucial that we realize that healthcare cannot be anything but a privilege, a wish, a desire. To make it a right deprives others of their rights. Period. No way around it.

That said, what makes you think healthcare is a right and not a privilege?



So you have the right to live, although natural circumstances may impede this without violating that right (i.e., lightning, drowning, cancer, etc.). You have the right to liberty (i.e., not being required to do things for others, not to be enslaved). And you have the right to pursue happiness.

Those are the basics rights according to the Constitution. Pretty simple, really. The right to life (of a sick person) vs. the right to liberty (of a healthcare provider) comes down to definition. The right to life seems most clearly to mean the right to not be murdered. That is, it is the right to remain alive. It is a passive right (just as the right to liberty) and is a right insofar as it does not impede on another person's rights.



To make healthcare a right, we must violate the final two clauses of Amendment V. The problem is that neither Congress nor the US Government has resources of its own. They must take resources from one person to give to another. In the form of taxes that pay for services we all use, we see just compensation (i.e., the Fire Dept serves us all, as does the military) in fairly uniform/equal ways; however, healthcare does not work this way (i.e., 95% of the resources are utilized by 5% of the population). In other words, someone is having wages taken from him/her and given to another in an illegal and unconstitutional manner.



Amendment X tells us that if the Constitution does not specify a right, the States and/or the People retain that right by default. In other words, the Constitution does not give the Federal Government the authority to take away a right to just compensation from healthcare providers in order to provide free healthcare to people in need.


Even the United Nations agrees (UN Declaration of Human Rights):

So the fact that someone is more wealthy than another person does not place his or her rights under those of another person who is less wealthy. Unfortunately, this needs to be stated, as it is often an argument people will make -- the fallacy of Robin Hood economics.

See above.... This is basically a direct quote from the Declaration.


To be forced to provide care for someone who cannot pay is a form of slavery. It is prohibited by the UN.


This is violated on two levels: 1) a right to healthcare interferes with a healthcare provider's life and family, and 2) through the abuse of malpractice, a "rights" mentality promotes such attacks on the provider's honor and reputation.

A right to healthcare is a direct violation of both parts of this right.

2) To be paid for one's work is a human right according to the UN. If a client is unable to pay, one can choose to provide work charitably; however, to force any person to do said work for free is a direct violation of this right.

Funny how that (doesn't) work(s) out for physicians.... Regardless, to require healthcare workers to serve these people would deprive them of this right (due to limited resources and an inability to serve all of those people given the available resources, human or otherwise).

This could be considered the foundational right for a "right to healthcare;" however, as demonstrated above, this would be in direct violation of other rights. I would argue that a better way to approach these needs is through charitable support for these people.

1) Everyone has duties that must be fulfilled. This could be read as a condition upon which the other rights rely. If one is in violation of those duties, he or she might not enjoy all of these rights as a natural consequence. (E.g., if one does not pay for something, he or she may be forced to pay off the debt through servitude. Is this a violation of his or her rights?)

2) I would read this as basically saying your rights are limited by those of others (i.e., you may not utilize your rights to impinge upon the rights of others).

In other words, your rights should not allow you to walk on others' rights. My rights are my rights. Yours are yours. Where they clash, it is the passive aspect of the right that wins out (i.e., the part not requiring its "use"; the part we might called "defensive"). In the case of the right to healthcare, this would mean the freedom of another person (i.e., the healthcare provider).

While I support charity work and intend to do it myself as a large part of my eventual career, I see it as highly unethical to force someone into providing care for another person (free of charge) as it impinges upon the other person's rights.

First of all. We can discount pretty much everything you have mentioned in the UN Declaration of Human Rights. Simply by looking at the Palestinian/Israeli conflict one can make the argument the the US does not abide by the guidelines set forth there. Look at Syria as well. The most any nation has done is to impose sanctions. Again we are largely ignoring the guidelines in that situation.

If you want to argue on the basis of the pre-ample of the constitution then there are a lot of things wrong with your argument. When does and should the right to life apply? There are some very simple conditions that people die of that can be taken care of simply with a prescription or a routine surgery. These are things that people consider non-issues now-a-days but 100 years ago you would have died from them. We aren't talking about long and drawn out recoveries either. Some of these things are still cost prohibitive though. Should we let people die of something we cured decades ago simply b/c they can not afford to pay? If you are saying absolutely no care then when something bad happens to you we shouldn't have the Emergency Medical Treatment and Active Labor Act where the majority of hospitals are required to treat patients regardless of ability to pay and even residency status in emergency situations. While this program isn't directly covered by the US government, through cost shifting of the unpaid hospital bills of those who don't pay the tax payers end up footing the bill. You therefore cannot argue that when bad things happen your right to life is over because you will get treatment if you cannot pay and the tax payers indirectly pay for it.

Another example we can bring up is car insurance. In most states you are required to purchase car insurance if you want to operate a vehicle. People argue that no one forces you to drive but this isn't entirely true. Some areas of the country, where I grew up for instance, there is absolutely no public transportation, and no jobs are within walking distance. It can be argued therefore that if I wanted to pursue my right to happiness and liberty (as you argue I am guaranteed) I need to purchase car insurance. You also cannot say that it was my choice to live there or that anyone living in that area had the option of moving. They don't. For monetary or familial or whatever reasons not everyone has that option. Even in areas that have access to public transportation employers will ask you if you have access to your own vehicle. If you don't you won't get the job. If you feel the mandate is coercion you would have a hard time arguing that car insurance isn't as well.

 

[sibitrum]

The irony is that if the scotus strikes this law down, the most likely result in the medium term is that there will be further expansions of medicaid/medicare. As a result, the market will become even less private. In addition, private insurers will be royally screwed if only the mandate is struck down, because then they will be vulnerable to extensive adverse selection.

 

[SurfingDoctor]

The irony is that if the scotus strikes this law down, the most likely result in the medium term is that there will be further expansions of medicaid/medicare. As a result, the market will become even less private. In addition, private insurers will be royally screwed if only the mandate is struck down, because then they will be vulnerable to extensive adverse selection.

Actually, everyone will have a problem if only the mandate is struck down. Yes, the private insurance caps and restrictions will be removed, but people previously not eligible for Medicaid will suddenly become eligible. This group of Medicaid eligible people where not buying private insurance to bring with and thus will not effect the number of people buying private insurance. However, if the mandate is struck down, the funds for the expansion of Medicaid essentially dry up, making the deficits assoicated to Medicaid/Medicare larger. Also, because the funds will not be there, but new people will be able to get healthcare, the reimbursement rates are likely to decrease. To make up for this decrease, hospitals/doctors will have to charge private insurances more, which will already likely increase their premiums to off set the added costs of no coverage maximums and pre-existing conditions. I think if the mandate gets thrown out (which I hope it doesn't), but everything else stays, the financial burden is likely to increase for everyone.

 

[SurfingDoctor]

While I support charity work and intend to do it myself as a large part of my eventual career, I see it as highly unethical to force someone into providing care for another person (free of charge) as it impinges upon the other person's rights.

Sorry, but this is unrealistic thinking. If you actually plan on being a physician to support yourself and your family, you will not take what little free time you have and donate it for free. Sure you can do little things here and there, but number of people impacted can be counted on 2 hands. I see a medical students make posts like this having no knowledge of what practicing medicine is actually like.

Also you may think it is unethical to "force" someone to pay for someone else's case, but guess what, you're already are being charged. You know that $300 copay you have to give everytime you go the emergency room, that copay helps offset the hospital cost of providing care to those who can't afford it. Now if you paid into the overall system, your copay would go down because you wouldn't have to make up for that difference because the hospital wouldn't lose as much money on the uninsured (as there wouldn't be any).

Lastly, with regards to the whole right vs commodity discussion, the Constitution, as hard as you might look, doesn't give a specific answer. It only gives someone an answer when they read into it and try to justify for their own opinion. The Constitution was written with the intent of protecting colonists from a monarchy, nothing more. Arguments like "it's unconstitutional" are the same they used to prevent abolition or women's sufferage because of the word "man", which historically neither blacks nor women where though to be apart of. If you interpreted it that way today, well you might not have a lot of ground to stand on. You can read into all you want, but healthcare just isn't in there because the founding fathers didn't consider it. But, if you think healthcare is a commodity, I challenge all of you to try to tell that to a patient or a patient's loved one when they are right in front of you. Besides going against the Hippocratic Oath, I would suspect both you and the patient would have a hard time dealing with someone dying or becoming severely ill in front of you because they couldn't pay you. But according to your argument, it's not your job (though you plan on becoming a physician) to help them, even though the financial impact to you would be negligible (unless you are doing that that charity work you promise to do). You are going to have a very hard time in medicine if you really believe that.

 

[Big Dog]

"the financial burden is likely to increase for everyone."


The simple fact is that those who are low income and currently without insurance will be provided insurance for essentially no-cost. Thus, "everyone" else, i.e., other taxpayers, will pick up the tab.

 

[music2doc]

Sorry, but this is unrealistic thinking. If you actually plan on being a physician to support yourself and your family, you will not take what little free time you have and donate it for free. Sure you can do little things here and there, but number of people impacted can be counted on 2 hands. I see a medical students make posts like this having no knowledge of what practicing medicine is actually like.

As long as I am able, I will do charity work on the side. Sure, I doubt I will do much until loans are paid off, because I realize those costs are extremely high, but once I am able, I intend to.

Also you may think it is unethical to "force" someone to pay for someone else's case, but guess what, you're already are being charged. You know that $300 copay you have to give everytime you go the emergency room, that copay helps offset the hospital cost of providing care to those who can't afford it. Now if you paid into the overall system, your copay would go down because you wouldn't have to make up for that difference because the hospital wouldn't lose as much money on the uninsured (as there wouldn't be any).

I am well-aware of this. I work in the ED. I would argue that EMTALA itself is not really constitutional. At the same time, I would hope EDs would do their best to accommodate charity patients. My argument is primarily that no one should be forced to take these patients. It is part of the Hippocratic Oath that we do care for them. In part, I would argue this because it discourages the attitude many people have that they can just go to the ED for primary care and not pay anything for their care. My argument really comes down to the simple fact that we cannot afford to provide unlimited healthcare. The resources simply are not there. The legal argument is simply to provide a legal support for one way to fix the issue. I would really argue that we either need to keep the entire reform bill (including EMTALA and the mandate) or dump the entire bill (which would have to include EMTALA). I suspect that that law was a major part of what got us here in the first place. The individual mandate is simply a fix to the natural consequences.

Lastly, with regards to the whole right vs commodity discussion, the Constitution, as hard as you might look, doesn't give a specific answer. It only gives someone an answer when they read into it and try to justify for their own opinion. The Constitution was written with the intent of protecting colonists from a monarchy, nothing more. Arguments like "it's unconstitutional" are the same they used to prevent abolition or women's sufferage because of the word "man", which historically neither blacks nor women where though to be apart of. If you interpreted it that way today, well you might not have a lot of ground to stand on. You can read into all you want, but healthcare just isn't in there because the founding fathers didn't consider it. But, if you think healthcare is a commodity, I challenge all of you to try to tell that to a patient or a patient's loved one when they are right in front of you. Besides going against the Hippocratic Oath, I would suspect both you and the patient would have a hard time dealing with someone dying or becoming severely ill in front of you because they couldn't pay you. But according to your argument, it's not your job (even though you plan on becoming a physician) to help them, even though the financial impact to you would be negligible (unless you are doing that that charity work you promise to do). You are going to have a very hard time in medicine if you really believe that.

 

[music2doc]

First of all. We can discount pretty much everything you have mentioned in the UN Declaration of Human Rights. Simply by looking at the Palestinian/Israeli conflict one can make the argument the the US does not abide by the guidelines set forth there. Look at Syria as well. The most any nation has done is to impose sanctions. Again we are largely ignoring the guidelines in that situation.

If you want to argue on the basis of the pre-ample of the constitution then there are a lot of things wrong with your argument. When does and should the right to life apply? There are some very simple conditions that people die of that can be taken care of simply with a prescription or a routine surgery. These are things that people consider non-issues now-a-days but 100 years ago you would have died from them. We aren't talking about long and drawn out recoveries either. Some of these things are still cost prohibitive though. Should we let people die of something we cured decades ago simply b/c they can not afford to pay? If you are saying absolutely no care then when something bad happens to you we shouldn't have the Emergency Medical Treatment and Active Labor Act where the majority of hospitals are required to treat patients regardless of ability to pay and even residency status in emergency situations. While this program isn't directly covered by the US government, through cost shifting of the unpaid hospital bills of those who don't pay the tax payers end up footing the bill. You therefore cannot argue that when bad things happen your right to life is over because you will get treatment if you cannot pay and the tax payers indirectly pay for it.

Another example we can bring up is car insurance. In most states you are required to purchase car insurance if you want to operate a vehicle. People argue that no one forces you to drive but this isn't entirely true. Some areas of the country, where I grew up for instance, there is absolutely no public transportation, and no jobs are within walking distance. It can be argued therefore that if I wanted to pursue my right to happiness and liberty (as you argue I am guaranteed) I need to purchase car insurance. You also cannot say that it was my choice to live there or that anyone living in that area had the option of moving. They don't. For monetary or familial or whatever reasons not everyone has that option. Even in areas that have access to public transportation employers will ask you if you have access to your own vehicle. If you don't you won't get the job. If you feel the mandate is coercion you would have a hard time arguing that car insurance isn't as well.

I would argue that we either need the individual mandate AND EMTALA or we must repeal both. One without the either encourages free-riding the system and leads to insane abuse of the healthcare system -- especially in terms of EMS. I do not see the individual mandate as necessarily overstepping any bounds if, in fact, it serves everyone equally.

 

[ppfizenm]

I would argue that we either need the individual mandate AND EMTALA or we must repeal both. One without the either encourages free-riding the system and leads to insane abuse of the healthcare system -- especially in terms of EMS. I do not see the individual mandate as necessarily overstepping any bounds if, in fact, it serves everyone equally.

You can't advocate for getting rid of or keeping the latter b/c that isn't what is up for debate. The point was that no one can claim there isn't a basis for the mandate when currently the US tax payers are technically already subsidizing healthcare for the uninsured.

 

[music2doc]

You can't advocate for getting rid of or keeping the latter b/c that isn't what is up for debate. The point was that no one can claim there isn't a basis for the mandate when currently the US tax payers are technically already subsidizing healthcare for the uninsured.

Sure, one can. The reality is that the two laws essentially require one another. If the individual mandate is illegal/unconstitutional, then so is EMTALA. The problem is that no politician would want to touch EMTALA with a very long stick! Trying to repeal that law would be career suicide! As a result, the individual mandate would make sense to uphold (if only because it is necessitated by an illegal law.)

 

[ppfizenm]

Sure, one can. The reality is that the two laws essentially require one another. If the individual mandate is illegal/unconstitutional, then so is EMTALA. The problem is that no politician would want to touch EMTALA with a very long stick! Trying to repeal that law would be career suicide! As a result, the individual mandate would make sense to uphold (if only because it is necessitated by an illegal law.)

But you can't. That's like saying we would need to reevaluate the 14th amendment every time gay rights came up for debate.

 

[link2swim06]

Sure, one can. The reality is that the two laws essentially require one another. If the individual mandate is illegal/unconstitutional, then so is EMTALA. The problem is that no politician would want to touch EMTALA with a very long stick! Trying to repeal that law would be career suicide! As a result, the individual mandate would make sense to uphold (if only because it is necessitated by an illegal law.)

The interesting thing that the supreme court justices brought up on Tuesday is they dont think the mandate is a regulation on healthcare but rather a regulation on the insurance market. They don't like the idea of people being forced into the commerce of the insurance market.

EMTALA is a regulation on healthcare which is very different. Its not forcing anyone into private commerce. EMTALA simply is an agreement to get medicare funding/payments for your hospital you agree treat everyone for emergency care. If you dont take medicare funding/payments as a hospital you have ZERO obligation to treat anyone for emergency care. Therefore neither the patient nor the hospital is obligated to treat if existing as solely private entities.

 

[ppfizenm]

The interesting thing that the supreme court justices brought up on Tuesday is they dont think the mandate is a regulation on healthcare but rather a regulation on the insurance market. They don't like the idea of people being forced into the commerce of the insurance market.

EMTALA is a regulation on healthcare which is very different. Its not forcing anyone into private commerce. EMTALA simply is an agreement to get medicare funding/payments for your hospital you agree treat everyone for emergency care. If you dont take medicare funding/payments as a hospital you have ZERO obligation to treat anyone for emergency care. Therefore neither the patient nor the hospital is obligated to treat if existing as solely private entities.

Virtually every hospital in the country is required to treat these people b/c they can't afford not to take the money. I guess going out of business is always a viable option though.

 

[SurfingDoctor]

I would argue that we either need the individual mandate AND EMTALA or we must repeal both.

Repeal an act that is essentially something that an ethical person would do anyway? Sorry, but that ain't going to fly since there is a good number of people in medicine who don't value money over life. The only hospitals/ERs that I have seen that don't uphold this act end up on the nightly news for patients dying, and those hospitals get shut down due to financial problems of malpractice and lack of revenues from bad press.

http://www.msnbc.msn.com/id/19207050/ns/health-health_care/t/woman-dies-er-lobby-refuses-help/

While this isn't exactly the same, the hospital would have a hard time defending itself from public backlash if it just refused care. And if the public refuses to go to that hospital... well they have no revenues and shut down (like the hospital in the story).

 

[Big Dog]

The point was that no one can claim there isn't a basis for the mandate...

A couple of federal judges have written extensively that the claim in indeed valid. Indeed, that is why the case was discussed in DC this week. If there was no basis for the claim, the courts would have disposed of this case a long time ago and the Supremes would not have accepted it.

btw: Under its extremely broad taxing authority, Congress could have easily obtained its coverages goal by calling for a healthcare tax on all, and then providing tax credits to those with appropriate insurance. But Congress purposely chose not to use its taxing authority to enact healthcare reform. (A tax never would have passed.)

 

[link2swim06]

Virtually every hospital in the country is required to treat these people b/c they can't afford not to take the money. I guess going out of business is always a viable option though.

While that is true, from a constitutional standpoint this significantly differentiates EMTALA from the individual mandate. The existence of the option to opt out is what makes EMTALA constitutional....

 

[ppfizenm]

While that is true, from a constitutional standpoint this significantly differentiates EMTALA from the individual mandate. The existence of the option to opt out is what makes EMTALA constitutional....

Virtually it's the option to exist or not exist which isn't really an option at all. The implications are the same for hospitals participating as it is for the insured now if some "opt" out of EMTALA. They are left to pick up the slack further straining resources. You could say that any person who doesn't like that mandate and doesn't want to pay the penalty is free to leave the country then. There's the option.

 

[ppfizenm]

A couple of federal judges have written extensively that the claim in indeed valid. Indeed, that is why the case was discussed in DC this week. If there was no basis for the claim, the courts would have disposed of this case a long time ago and the Supremes would not have accepted it.

btw: Under its extremely broad taxing authority, Congress could have easily obtained its coverages goal by calling for a healthcare tax on all, and then providing tax credits to those with appropriate insurance. But Congress purposely chose not to use its taxing authority to enact healthcare reform. (A tax never would have passed.)

I suppose it's coincidence that the only states where the bill was challenged successfully had republican governors and those where it wasn't successfully challenged had democratic governors.The lower courts were mainly used as political power plays so we shouldn't judge the merits of the claim based on their decisions.

 

[link2swim06]

Virtually it's the option to exist or not exist which isn't really an option at all. The implications are the same for hospitals participating as it is for the insured now if some "opt" out of EMTALA. They are left to pick up the slack further straining resources. You could say that any person who doesn't like that mandate and doesn't want to pay the penalty is free to leave the country then. There's the option.

Why couldn't I exist if I only took private insurance and cash? Granted I wouldn't have as many patients as if I took medicare/medicaid...but nevertheless it is not an option "not to exist."

Many individual physicians refuse medicare and medicaid all the time....they do just fine.

Here is what it comes down to....hospitals either (1) are non-profit and have goals which are in-align with that....i.e. treat everyone who walks through the doors (2) for profit hospitals still earn more money with medicare even though they have to take some uninsured people.

I dont see ANY proof on your part that shows a private insurance/ cash only hospital couldn't exist.

 

[ppfizenm]

Why couldn't I exist if I only took private insurance and cash? Granted I wouldn't have as many patients as if I took medicare/medicaid...but nevertheless it is not an option "not to exist."

Many individual physicians refuse medicare and medicaid all the time....they do just fine.

Here is what it comes down to....hospitals either (1) are non-profit and have goals which are in-align with that....i.e. treat everyone who walks through the doors (2) for profit hospitals still earn more money with medicare even though they have to take some uninsured people.

I dont see ANY proof on your part that shows a private insurance/ cash only hospital couldn't exist.

Private insurance/cash only hospitals generally avoid emergency care altogether (so talking about EMTALA becomes pointless in these cases) which as I said shifts more burden onto an already strained system. Show me proof the a for profit hospital, offering all the services of a non-profit, can operate at the same level.

 

[music2doc]

Repeal an act that is essentially something that an ethical person would do anyway? Sorry, but that ain't going to fly since there is a good number of people in medicine who don't value money over life. The only hospitals/ERs that I have seen that don't uphold this act end up on the nightly news for patients dying, and those hospitals get shut down due to financial problems of malpractice and lack of revenues from bad press.

http://www.msnbc.msn.com/id/19207050/ns/health-health_care/t/woman-dies-er-lobby-refuses-help/

While this isn't exactly the same, the hospital would have a hard time defending itself from public backlash if it just refused care. And if the public refuses to go to that hospital... well they have no revenues and shut down (like the hospital in the story).

I absolutely agree that an ethical person would serve these people regardless. However, to require such is to infringe upon a person's rights. Further, the fact that people know they can rely upon healthcare regardless of ability to pay encourages freeloading. Why not limit the services available without paying and make those services available for free to everyone? Otherwise, we are basically encouraging people to go uninsured. I have heard more than one person say they would consider dropping their insurance because it costs a lot and someone without insurance can often get better coverage through charity programs! That kind of attitude is what makes me livid. That is the problem I would like to see fixed, whether it is through an individual mandate or the repeal of a law from the 1980s. With the current state of limbo we are in, healthcare is not sustainable in this country.

While that is true, from a constitutional standpoint this significantly differentiates EMTALA from the individual mandate. The existence of the option to opt out is what makes EMTALA constitutional....

As been mentioned, however, such an "option to opt out" is essentially non-existent. Sure, there are probably ways to work-around it, but they would greatly decrease the kinds of patients you could help in the community to such a degree as to be essentially not a viable option. (The language of the law also seems to make it clear that this was the intention. The breadth of the language appears to intentionally make workarounds quite impractical.)

Why couldn't I exist if I only took private insurance and cash? Granted I wouldn't have as many patients as if I took medicare/medicaid...but nevertheless it is not an option "not to exist."

Many individual physicians refuse medicare and medicaid all the time....they do just fine.

Here is what it comes down to....hospitals either (1) are non-profit and have goals which are in-align with that....i.e. treat everyone who walks through the doors (2) for profit hospitals still earn more money with medicare even though they have to take some uninsured people.

I dont see ANY proof on your part that sho,ws a private insurance/ cash only hospital couldn't exist.

The issue, as I see it, would be an ethical one. From a financial perspective, refusing all Medicare, Medicaid, Tricare, and uninsured/self-pay patients makes sense as these 4 are generally all a loss to the hospital. (Medicare, Medicaid, and Tricare all pay substantially below cost for many/most procedures as I understand, so to deny all of those and only take commercial insurance and cash-before-being-seen patients would actually increase profits.) However, I would not want to turn away those actually taking care of their health who are on Medicare/Medicaid/Tricare/uninsured.

The ones I would want to have that option on would be the futile or unnecessary care cases, such as the woman who came into our ED 800 times last year (2-3 times per day) for her "chronic pain." Each time, she would call 9-1-1, waste EMS' resources to get to the hospital, demand medications, waste a room, etc., etc., etc. and yet we cannot tell her to go home. If she chooses to remain in our ED or wants to check back in, no one can simply tell her, "Ma'am, we've done all we can do. I'm sorry." Instead, we have to take her in and treat her again and again and again. It makes no sense. It wastes resources. This woman alone, made up 1.0% of our ER visits last year! That's incredible -- especially in an area of the country with some of the worst ED overcrowding nationwide! (One of our local EDs is one of the top 10 busiest EDs in the country.... The ED where I work is the second largest and busiest in the region and serves to relieve that overcrowding in many cases.)

 

[link2swim06]

Private insurance/cash only hospitals generally avoid emergency care altogether (so talking about EMTALA becomes pointless in these cases) which as I said shifts more burden onto an already strained system. Show me proof the a for profit hospital, offering all the services of a non-profit, can operate at the same level.

We are no longer arguing on the same topic.

I am making a point why EMTALA is constitutional, not why opting out of medicare is a good business decision. The poster above us statement EMTALA and the individual mandate are unconstitutional. I am trying to explain why that isn't true.

Listen to the supreme court justices Tuesday discussion, they aren't interested in what the best business decision is nor the best solution to healthcare, that isnt their purpose. The point is nowhere are hospitals forced into EMTALA, they elect to except it along with medicare.

Many hospital systems like the VA, Military, Indian health service, and Shriner for Children (up till recently) ran on completely separate funding schemes which exempted them from EMTALA.

Finally, there is no reason a concierge type hospital couldn't open near a particular rich community. This hospital could have an ED and not accept people w/o money. Honestly, this these types of hospitals are going to start appear when the healthcare system implodes.

 

[SurfingDoctor]

I absolutely agree that an ethical person would serve these people regardless. However, to require such is to infringe upon a person's rights.

I don't understand this argument? You are saying that one has the right to be unethical? Ok, I suppose, but typically actions that are unethical are against the law. I think a jury would have a hard time not finding one liable of malice, or at least negligance (as the case above) if a physician could help someone in a business they worked at and chose not to and let them die because it was their "right". People also felt it was their "right" to own slaves... that didn't work out to well for them.

 

[link2swim06]

I don't understand this argument? You are saying that one has the right to be unethical? Ok, I suppose, but by that logic, one would have the right to commit murder. The law and 99.9% of society feel differently though.

His logic is if "healthcare" is a right then healthcare workers are forced to treat everyone. When I graduate in 2 years is it the general public's right to force me to provide care if they come to see me? If so then isnt my freedom impinged on...if I am obligate by law? What if all my patients have no money, then I basically have to work for free bc it is "their legal right."

 

[link2swim06]

I don't understand this argument? You are saying that one has the right to be unethical? Ok, I suppose, but typically actions that are unethical are against the law. I think a jury would have a hard time not finding one liable of malice, or at least negligance (as the case above) if a physician could help someone in a business they worked at and chose not to and let them die because it was their "right".

So in other words, everyone who drives past an car accident that could have helped should go to jail for negligence?

 

[link2swim06]

I don't understand this argument? You are saying that one has the right to be unethical? Ok, I suppose, but typically actions that are unethical are against the law. I think a jury would have a hard time not finding one liable of malice, or at least negligance (as the case above) if a physician could help someone in a business they worked at and chose not to and let them die because it was their "right".

So in other words, everyone who drives past an car accident that could have helped should go to jail for negligence?

 

[ppfizenm]

We are no longer arguing on the same topic.

I am making a point why EMTALA is constitutional, not why opting out of medicare is a good business decision. The poster above us statement EMTALA and the individual mandate are unconstitutional. I am trying to explain why that isn't true.

Listen to the supreme court justices Tuesday discussion, they aren't interested in what the best business decision is nor the best solution to healthcare, that isnt their purpose. The point is nowhere are hospitals forced into EMTALA, they elect to except it along with medicare.

Many hospital systems like the VA, Military, Indian health service, and Shriner for Children (up till recently) ran on completely separate funding schemes which exempted them from EMTALA.

Finally, there is no reason a concierge type hospital couldn't open near a particular rich community. This hospital could have an ED and not accept people w/o money. Honestly, this these types of hospitals are going to start appear when the healthcare system implodes.

Just ignore the poster above us. I have listened to the supreme court justices and understand what there job is. The hospitals that you mention here (VA, indian, Military) that are exempt EMTALA do not constitute a majority of hospitals and are not for profit hospitals. I understand the EMTALA is constitutional and not am not arguing that it isn't. My argument centered around the fact that it does provide a foundation for the individual mandate of the PPACA. The opt out as you mentioned is a viable option for hospitals that do not offer emergency services. The reason they don't is b/c ER's operate at high costs with low compensatory return. I could picture minimally staffed private ER's catering to wealthy individuals as, at the most, cost sufficient. While this works on the small scale, not every hospital in the country has the option of opting out of EMTALA. The more hospitals that do it, the heavier burden it places it on the ones still offering those services. Eventually, if hospitals keep opting out, the whole program becomes pointless and the federal government would step in and force hospitals to take the uninsured for emergency treatment (basically what EMTALA was). None of this changes that fact that much of this emergency treatment is still subsidized by the American tax payers. Technically we are already paying for the healthcare of others.

 

[SurfingDoctor]

So in other words, everyone who drives past an car accident that could have helped should go to jail for negligence?

Nope, bystanders don't have experise in medical aid nor are they getting paid to render aid. From a legal definition, it could be consider negligent if someone getting paid to provide care chose not to while still getting paid (ie the EMTs show up and just stand around). However, if a physician drives by an accident, without rendering aid, it's not negligent, but it certainly is unethical.

 

[music2doc]

His logic is if "healthcare" is a right then healthcare workers are forced to treat everyone. When I graduate in 2 years is it the general public's right to force me to provide care if they come to see me? If so then isnt my freedom impinged on...if I am obligate by law? What if all my patients have no money, then I basically have to work for free bc it is "their legal right."

Precisely. If I am out at a restaurant and someone comes up to me asking for money because they need something to eat, am I obligated to give that person whatever I have on me, since hunger is a life-sustaining need? (Of course not! However, I most likely will buy that person something to eat at the restaurant because that is who I am. It is not that person's "right" to eat on my dime. I choose to give freely out of my own free will.)

Likewise, if I am out hiking and come across a young woman who is having an allergic reaction (specifically, anaphylaxis), is it her right that I run back to my car, open my first aid kit, and grab an epi-pen (yes, I have one in my FA kit) to treat her? (Once again, I would have to say no. It's not her right. I will gladly do it because I'm not going to let her die, but it's not her right that I treat her. It's my choice based on my sense of morality.)

My argument boils down to whether or not others have a right to the services a healthcare worker/professional is able to offer. I would argue that no, a person cannot have a right to receive services from someone else even with pay. (I.e., even if you offer a salon $20 to give you a haircut, it is absolutely within their right to say, "No thank you" regardless of whether or not they could take you. Generally, this would be a poor business practice, but there are specific cases -- such as if you had been a d-bag in the past to their employees -- in which you might get refused. Hospital EDs generally do not have that privilege.)

 

[music2doc]

Nope, bystanders don't have experise in medical aid nor are they getting paid to render aid. From a legal definition, it could be consider negligent if someone getting paid to provide care chose not to while still getting paid (ie the EMTs show up and just stand around). However, if a physician drives by an accident, without rendering aid, it's not negligent, but it certainly is unethical.

If the person is non-paying, they are not paying for your services. Negligence as defined by whether or not you are being paid implies a social contract (i.e., paying = getting services). If the candidate to receive services does not pay, the social contract is non-existent and we are back to the question of whether or not an unpaid healthcare worker is legally obligated to help a person in need (ethical obligations aside, since if able, a healthcare worker should be internally motivated to help said person without the need for an ethical obligations).

 

[SurfingDoctor]

But as a physician it is one's job (ie, what you get paid for) to help those who ask for your assistance. If you don't do the job that you are paid for then you are negligent (from a legal standpoint). You can get into the semantics of, "Well, it not my responsibility" but guess what, society says otherwise. Most of the people in the medical profession and the ones with any power or responsiblity also feel the same. If you don't, yep it's your "right", but should wonder why you are going into a profession whose basis and ethos is so strongly against your beliefs. If you think you can change it, well best of luck, but you won't have my support.

Also comparing a life sparing intervention to a haircut... I can't even argue that.

 

[music2doc]

But as a physician it is one's job (ie, what you get paid for) to help those who ask for your assistance. If you don't do the job that you are paid for then you are negligent (from a legal standpoint). You can get into the semantics of, "Well, it not my responsibility" but guess what, society says otherwise. Most of the people in the medical profession and the ones with any power or responsiblity also feel the same. If you don't, yep it's your "right", but should wonder why you are going into a profession whose basis and ethos is so strongly against your beliefs. If you think you can change it, well best of luck, but you won't have my support.

Also comparing a life sparing intervention to a haircut... I can't even argue that.

I completely agree with helping people who are in need. Where we disagree is in whether or not it is a "right." In practice, it makes little difference. I will still be there for these people regardless. I simply find it somewhat offensive that people would consider my time, my sweat, my blood, my tears their "right." It is my "right" to give of myself; not their "right" to take. I would never refuse to do the job put in front of me, but no one should be forcing it upon me. No one should "expect" to be given care for free. It should simply be offered to them without charge if they are unable to pay. The "requirement," not the work, is what I find offensive.

 

[SurfingDoctor]

I would never refuse to do the job put in front of me, but no one should be forcing it upon me.

No one is forcing you to become a physician but by becoming a physician, you have a duty to society. Whether you like it or not, that's the way it is (and the way it should be).

You can debate this all you want in a medical ethics discussion, and because it is an ethics discussion, you can never be told you are wrong, but that doesn't mean you are right either. Either way, none of this has to do with the Affordable Healthcare Act (which does not address denial of services by physicians). If you are bored you can read up on medical ethics:

http://www.ama-assn.org/ama/pub/phy...medical-ethics/principles-medical-ethics.page

This is the AMA's stance on the individual mandate. I would say it has the most weight to it because it comes from experts with experience in medical practice, policy and ethics. http://virtualmentor.ama-assn.org/2011/11/pfor3-1111.html. If you disagree, that's fine, but you would be in the minority.

Good luck.

 

[music2doc]

No one is forcing you to become a physician but by becoming a physician, you have a duty to society. Whether you like it or not, that's the way it is (and the way it should be).

You can debate this all you want in a medical ethics discussion, and because it is an ethics discussion, you can never be told you are wrong, but that doesn't mean you are right either. Either way, none of this has to do with the Affordable Healthcare Act (which does not address denial of services by physicians). If you are bored you can read up on medical ethics:

http://www.ama-assn.org/ama/pub/phy...medical-ethics/principles-medical-ethics.page

This is the AMA's stance on the individual mandate. I would say it has the most weight to it because it comes from experts with experience in medical practice, policy and ethics. http://virtualmentor.ama-assn.org/2011/11/pfor3-1111.html. If you disagree, that's fine, but you would be in the minority.

Good luck.

OK. I am willing to concede that, but if we do, in fact, consider healthcare a right, then how do we provide for everyone's health? Is this not what the PPACA is attempting to address? Given the resources we have, how can we fulfill this right for everyone? Does the individual mandate solve the inherent problems? Will it truly solve the access issue? Do we have the necessary personnel, funding, supplies, etc.?

(My understanding has always been that the answer is no, which is why I cannot see how one can maintain that this is a right. If it is, in fact, viable to offer unrestricted care to everyone, then by all means, let's do it! And I apologize for being misinformed.)

 

[candav]

This is the fundamental question. And while I absolutely believe we should give charitably and that we should do our best to serve those who cannot afford care, I think it is crucial that we realize that healthcare cannot be anything but a privilege, a wish, a desire. To make it a right deprives others of their rights. Period. No way around it.

Not much to add to this conversation that hasn't already been said, but I just wanted to point out that so-called "fundamental" rights can be and are limited on a regular basis, as long as there is sufficient social benefit in doing so. Funny that you quote the UDHR, which is not a legally binding document. The ICESCR, which is legally binding (thought the US has no ratified it), recognizes "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" -- clearly, not a reality when some have better access to health care than others.

Being a physician is not like most other jobs, and carries a special set of benefits, and of sacrifices. It would not be farfetched to say that physicians worldwide should not be allowed the right to strike, for example. All this to say that the individual rights of physicians as people are regularly overridden in the name of the social good -- and in the case of health care reform, I am okay with it.

 

[NickNaylor]

No one is forcing you to become a physician but by becoming a physician, you have a duty to society. Whether you like it or not, that's the way it is (and the way it should be).

You can debate this all you want in a medical ethics discussion, and because it is an ethics discussion, you can never be told you are wrong, but that doesn't mean you are right either. Either way, none of this has to do with the Affordable Healthcare Act (which does not address denial of services by physicians). If you are bored you can read up on medical ethics:

http://www.ama-assn.org/ama/pub/phy...medical-ethics/principles-medical-ethics.page

This is the AMA's stance on the individual mandate. I would say it has the most weight to it because it comes from experts with experience in medical practice, policy and ethics. http://virtualmentor.ama-assn.org/2011/11/pfor3-1111.html. If you disagree, that's fine, but you would be in the minority.

Good luck.

That's YOUR construction of what it means to be a physician. Why does the physician have a duty to society rather than his individual patients? When did to-be physicians agree to work for "society?"

I'm not necessarily disagreeing with you (I agree that physicians have SOME obligation to society, but that by no means subjugates them to the public), but it's easy to simply vomit out a bunch of crap that has been repeated ad nauseum with no backing or explanation.

 

[link2swim06]

No one is forcing you to become a physician but by becoming a physician, you have a duty to society. Whether you like it or not, that's the way it is (and the way it should be).

You can debate this all you want in a medical ethics discussion, and because it is an ethics discussion, you can never be told you are wrong, but that doesn't mean you are right either. Either way, none of this has to do with the Affordable Healthcare Act (which does not address denial of services by physicians). If you are bored you can read up on medical ethics:

http://www.ama-assn.org/ama/pub/phy...medical-ethics/principles-medical-ethics.page

This is the AMA's stance on the individual mandate. I would say it has the most weight to it because it comes from experts with experience in medical practice, policy and ethics. http://virtualmentor.ama-assn.org/2011/11/pfor3-1111.html. If you disagree, that's fine, but you would be in the minority.

Good luck.

Hmm that interesting because 71% of physicians are NOT members of the AMA.

I dont think its accurate to say whatever the AMA comes up with is the majority of physician's opinion. Without some sort of poll or survey you really are just making **** up by claiming minority/majority opinion.

 

[music2doc]

This is the AMA's stance on the individual mandate. I would say it has the most weight to it because it comes from experts with experience in medical practice, policy and ethics. http://virtualmentor.ama-assn.org/2011/11/pfor3-1111.html. If you disagree, that's fine, but you would be in the minority.

Good luck.

Nothing of the AMA's stance is at all contradictory to what I believe would be best. I have simply stated that to have universal access would require that all people be required to pay in. With the Supreme Court arguing over whether or not this can happen, the only other sustainable option would seem to be to not support those who cannot pay -- at least not from a legal standpoint (i.e., it does not appear to be sustainable to pay for people who choose not to pay for themselves and/or who habitually abuse EMS-type services without paying).

Requirements of individual responsibility were deemed necessary by the AMA to avoid the free-rider problem, in which care for the uninsured is paid for by others, and adverse selection, which occurs when low-risk individuals opt out of insurance, because both circumstances raise costs for everyone else [10]. In its 2006 report “Individual Responsibility to Obtain Health Insurance,” the council noted that

there are some individuals with high incomes whose failure to obtain health insurance poses an avoidable social burden. Such individuals have a responsibility to obtain coverage. Individuals with lower incomes also have the responsibility to seek and maintain coverage, but their burden to do so is tempered by their ability to afford the potentially high cost of coverage [10].
​

Agreed.

First, in the context of an individual mandate, the AMA supports health insurance coverage of preexisting conditions with both guaranteed issue and guaranteed renewability [5]. Thus, it rejects an individual mandate that would require the purchase of health insurance but not ensure that individuals with preexisting conditions could receive it and renew it.

Such is necessary to cover people universally, therefore I would agree it is a positive thing.

 

[IRASNA]

This is a must read (and an easy read for those who fear law-jargon):

http://www.slate.com/articles/news_...he_court_s_conservative_justices_.single.html

 

[redsquareblack]

"the financial burden is likely to increase for everyone."


The simple fact is that those who are low income and currently without insurance will be provided insurance for essentially no-cost. Thus, "everyone" else, i.e., other taxpayers, will pick up the tab.

It's comments like this that drive me crazy.

Yes. THAT'S (PART OF) THE POINT OF THE INDIVIDUAL MANDATE. Sooner or later, the cost is passed on. That has never been a point of contention, so I'm not sure what you're getting at here. The question is, when the bill comes due, will the price be bigger or smaller?

 

[redsquareblack]

(if only because it is necessitated by an illegal law.)

If it is the law, then it is by definition legal. Not sure what's difficult to grasp about this.

It is also presumed to be constitutional, unless and until it is successfully struck down by the Supremes.