Obama wins.

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BYU2010

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Tomorrow is a very important day in the future of healthcare and medicine. I find this blog a good read http://www.scotusblog.com/.

Any thoughts?
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The way I understand it, whether or not the individual mandate is struck down has little to do with the coming reforms in how health care is delivered. Many health systems are already working to improve coordination among teams of physicians and non-physicians in order to cut costs and improve health outcomes. And, ideally, as health systems learn to become more coordinated, payment systems will shift away from ffs toward capitation structures (small physician practices, however, will likely continue with ffs because their patient population is generally too small to manage the risks involved with capitation). This is happening regardless of whether americans are forced to buy insurance.

Moreover, if the statute is upheld, does the US health system really have the primary-care workforce to handle the tens of millions of newly insured?
 
PreMedOrDead said:
C'mon Nick, 0/10

:corny:

Much better.

Dat der kommie Obama Hussein Barack dir bag gun get was comin' to 'em.

Read these comments

'Merika!
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Haha my bad, please forgive me. Using Tapatalk I don't get the shortcuts for all of the smilies so I have to guess.

(sent from my phone - please forgive typos)
 
NickNaylor said:
Haha my bad, please forgive me. Using Tapatalk I don't get the shortcuts for all of the smilies so I have to guess.

(sent from my phone - please forgive typos)
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I actually don't know what the code of the popcorn smiley is, I copy/paste the image. :laugh:
 
tanzacat said:
Moreover, if the statute is upheld, does the US health system really have the primary-care workforce to handle the tens of millions of newly insured?
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Only in Obama's wildest dreams would tens of millions of people actually become insured as a result of PPACA, with or without the mandate. Sure, many adult children will find extended coverage under their parents' insurance and a few people with preexisting conditions who are lucky enough to have enough money to buy insurance can now purchase it, but the vast majority of people - those to whom the bill was 'marketed' - will still find insurance priced out of their reach. The mandate itself is anything but; the fine is so small and applies to so few people who don't already have insurance that it does practically nothing. To be honest, were this not the case, the law would be outright cruel.
 
Ok I really feel like I need to catch up on everything that's going on. Where can I begin?
 
Cornu Ammonis said:
Only in Obama's wildest dreams would tens of millions of people actually become insured as a result of PPACA, with or without the mandate. Sure, many adult children will find extended coverage under their parents' insurance and a few people with preexisting conditions who are lucky enough to have enough money to buy insurance can now purchase it, but the vast majority of people - those to whom the bill was 'marketed' - will still find insurance priced out of their reach. The mandate itself is anything but; the fine is so small and applies to so few people who don't already have insurance that it does practically nothing. To be honest, were this not the case, the law would be outright cruel.
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I take it you haven't read much about the new insurance subsidies or the expansion of Medicaid then?

MedPR, I really like http://theincidentaleconomist.com/
 
I am definitely anxious even though I'm sure the individual mandate will be struck down and everything else will be sent back to Congress to be reworked. If the whole act is upheld, I will be very very very surprised.
 
UCFKnight said:
I am definitely anxious even though I'm sure the individual mandate will be struck down and everything else will be sent back to Congress to be reworked. If the whole act is upheld, I will be very very very surprised.
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There is no logical/legal difference between the "mandate" and the many other rebate programs written into tax laws for well over 100 years. To strike down the mandate would be to strike down EVERY other tax preference. Everything from rebates for home energy purchases to agricultural subsidies. It will be fun to watch. :)
 
UCFKnight said:
I am definitely anxious even though I'm sure the individual mandate will be struck down and everything else will be sent back to Congress to be reworked. If the whole act is upheld, I will be very very very surprised.
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I will be VERY surprised if it was upheld given how the court has been acting the last year or so. It's def going to be 5-4 and I'm expecting that its going to be all 5 conservatives vote to strike down and 4 vote upheld. Unless Chief Justice Roberts can be swayed but I don't find that likely. Now whether the whole thing or parts of it struck down, I'm not exactly sure...
 
argama said:
I will be VERY surprised if it was upheld given how the court has been acting the last year or so. It's def going to be 5-4 and I'm expecting that its going to be all 5 conservatives vote to strike down and 4 vote upheld. Unless Chief Justice Roberts can be swayed but I don't find that likely. Now whether the whole thing or parts of it struck down, I'm not exactly sure...
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Who, exactly, are these "5 conservatives"? Surely you don't intend to include Kennedy :confused:
 
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Dave89 said:
Who, exactly, are these "5 conservatives"? Surely you don't intend to include Kennedy :confused:
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:confused: A strong argument can be made that Justice Kennedy is the ONLY conservative on the court.
 
mimelim said:
I'd like to hear this 'strong argument'. Been following the SCOTUS off and on for 7-8 years reasonably closely and never had that impression.
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In a nutshell, Stare decisis! This is a defining principle of what it means to be a "conservative". There are four justices currently sitting on the court that have NO respect for the institution. They are radicals. A radical by definition, can not be a conservative.

Have you EVER read the writings of Antonin Scalia?? Scary stuff. :eek:
 
Opinion is in (via scotusblog):

"The individual mandate survives as a tax."
"So the mandate is constitutional. Chief Justice Roberts joins the left of the Court."
"The Medicaid provision is limited but not invalidated."
"The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read."
 
Reading it on scotusblog, live. Roberts joins the liberal justices and not Kennedy apparently (? Not sure, still figuring this out).

Interesting - thoughts? I thought it was a good idea - puts a lot more people into private insurance, but I wanted single payer....this means we probably won't get that.

Overall, entire law is held constitutional, except the medicaid expansion which is limited in some way but not eliminated.

I will post links to the opinion as they become available.



Source: http://www.scotusblog.com/
 
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Lokhtar said:
Reading it on scotusblog, live. Roberts joins the liberal justices and not Kennedy apparently (? Not sure, still figuring this out).

Interesting - thoughts? I thought it was a good idea - puts a lot more people into private insurance, but I wanted single payer....this means we probably won't get that.
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Single payer means lower doc salaries since the govt gets a monopsony in the labor market.
 
Also, medicaid expansion is not eliminated but it is limited in some way.
 
ElCapone said:
Single payer means lower doc salaries since the govt gets a monopsony in the labor market.
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It's going to be lower doc salaries no matter what. No party is looking to increase medicare reimbursement and private insurance tag their reimbursement to medicare (they usually pay an x% above that) - as long as medicare keeps dropping their payments (and they will), the doc salaries will go down. Not much you can do about that.
 
AtlasCarraway said:
Opinion is in (via scotusblog):

"The individual mandate survives as a tax."
"So the mandate is constitutional. Chief Justice Roberts joins the left of the Court."
"The Medicaid provision is limited but not invalidated."
"The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read."
Click to expand...

In his dissent, Justice Scalia stated that "if bloodletting was good enough for the father of our country, it's good enough for me"

:smuggrin::laugh:
 
Awesome. Physician salaries in some specialties are ridiculously high and need to be dropped anyway.
 
What happens now?

What shall we do? Where shall we go?
 
No part of the act has anything to do with that. I am not sure where you are getting this from.
 
The problem with the individual mandate is that the penalty for not participating isn't stiff enough. Insurance operates on the principle that everyone is a player. The way it stands, it will be more financially feasible for the healthiest members of the population (~ 30-40%) to simply not buy insurance and take the less expensive penalty. There's also not a stiff penalty to simply jump in and out of the system. So people can just buy back in when they get sick or anticipate illness, since you have to now cover people with pre-existing conditions. Over time, this will shoulder the brunt of the cost on the individuals accruing most of the health bill, namely 5-10% of the population, usually the elderly with chronic conditions.

Unless the bill is amended, insurance rates are going to skyrocket. I believe in universal coverage, but this blending of market forces and government mandates is setting us up for failure. The Germans, Canadians, and Taiwanese know what they're doing. We're just too stubborn to notice.

Just leave dentistry alone. :)
 
ElCapone said:
Single payer means lower doc salaries since the govt gets a monopsony in the labor market.
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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. Thus, your salary is lower initially, but if you keep your patients healthy and practice good preventative medicine, you could do really well coming out of school with no debt, no malpractice, and no overhead.

And in Germany, no one pays a PENNY for health care. Ever.
 
Spectacular victory.

I wish that more Americans would go into this issue with a more open mind, and EDUCATE themselves regarding all aspects of PPACA before voicing their premature and ignorant opinions.

Seriously, it's not perfect, but it's about the best that we've got.
 
diasIItema said:
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. Thus, your salary is lower initially, but if you keep your patients healthy and practice good preventative medicine, you could do really well coming out of school with no debt, no malpractice, and no overhead.

And in Germany, no one pays a PENNY for health care. Ever.
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Bismarck model?
 
coyotelime said:
Spectacular victory.

I wish that more Americans would go into this issue with a more open mind, and EDUCATE themselves regarding all aspects of PPACA before voicing their premature and ignorant opinions.

Seriously, it's not perfect, but it's about the best that we've got.
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lol tell that to the several specialist groups that actively denounced it (ASAHQ)
 
coyotelime said:
Spectacular victory.

I wish that more Americans would go into this issue with a more open mind, and EDUCATE themselves regarding all aspects of PPACA before voicing their premature and ignorant opinions.

Seriously, it's not perfect, but it's about the best that we've got.
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Maybe you should understand the mandate and it's consequences first.
 
The problem is that the health care law is wildly unpopular, with only 34% approval rating. While the administration can count it as a win, the populace may be very cranky. Granted, they're all afraid because they think the law will make them magically change doctors, so it's mostly fear based on stupidity.
 
BrainOnFire said:
The problem is that the health care law is wildly unpopular, with only 34% approval rating. While the administration can count it as a win, the populace may be very cranky. Granted, they're all afraid because they think the law will make them magically change doctors, so it's mostly fear based on stupidity.
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wow i didn't know it was so unpopular. I wish there was a direct article on what the impact on future physicians would be.
 
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.
 
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.
 
Hemorrage said:
wow i didn't know it was so unpopular. I wish there was a direct article on what the impact on future physicians would be.
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No one can tell you this immediately. For starters, the legislature may still try to overturn portions of it. Next, the provisions are being staggered in, so it's hard to really see the cost at one point in time. Medicare is probably going to swell, meaning less payouts, but let's face it: how many people on SDN are looking forward to working with Medicare-eligible patients? Most people are going to jet out of that racket ASAP.
 
TexasPhysician said:
Maybe you should understand the mandate and it's consequences first.
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Off the top of my head, rise in premium costs, maybe 12%? Seems astronomical, but not so bad if you consider that all Americans will be covered.

Oh, and if everyone has insurance, more people will use it, which means healthcare services will be in higher demand. This doesn't mean physicians/nurses/etc. will make more, but guarantees additional stability for those in the field.

Feel free to explain your side - I am interested in why some, especially physicians, oppose the mandate so strongly.
 
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.
 
BrainOnFire said:
No one can tell you this immediately. For starters, the legislature may still try to overturn portions of it. Next, the provisions are being staggered in, so it's hard to really see the cost at one point in time. Medicare is probably going to swell, meaning less payouts, but let's face it: how many people on SDN are looking forward to working with Medicare-eligible patients? Most people are going to jet out of that racket ASAP.
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How is medicare going to swell? It will due to the baby boomers retiring, but not due to anything in this bill.
 
TexasPhysician said:
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.
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Do you mean Medicaid? Medicare is for the elderly/people with disabilities/ALS/End-Stage Renal Disease.

If I'm not mistaken, won't the increased patient number offset costs of expanding hospitals, and potentially increasing medical expenses, if only to a certain extent?

My understanding is that many will qualify for Medicaid (133% of FPL) who did not before, so compensation may go down. But how about those healthy people who buy insurance to avoid the penalty? Is there a significantly larger % of people who will be on Medicaid because of the mandate/expanded coverage compared to those healthy middle class or above?

Edit: Bolded the compensation part. Could you provide an example of how much the average physician will be affected by the mandate?
 
In all honesty we need a Singapore like system here, i.e everyone pays 5% prior to taxes directly to the Health Care System.
 
TexasPhysician said:
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.
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The mandate doesn't increase medicare, as it's a private insurance mandate, with some provisions in the rest of the bill to increase medicaid for those who can't afford private insurance. Medicaid is a state-run entity. The reason your neurologist closed his clinic is probably due to the same reason many in my state closed, and that's massive cuts to subsidies from the STATE government, due to massive budget cuts.
 
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