Federal Judge rules Obamacare unconstitutional

[Doctodd]

so this just happened.....where's my popcorn....

Judge rules Obamacare unconstitutional, endangering coverage for 20 million

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[drusso]

so this just happened.....where's my popcorn....

Judge rules Obamacare unconstitutional, endangering coverage for 20 million

I've met Judge O'Connor; he's super-smart. Personally, I've never been comfortable with the idea that any government can compel a natural person and free-born citizen to buy a contract for service. If that were to stand, and you take it to its logical conclusion, what COULDN'T the government force you to do??? +1 for human rights FTW!

 

[drusso]

so this just happened.....where's my popcorn....

Judge rules Obamacare unconstitutional, endangering coverage for 20 million

Texas v US Partial Summary Judgment

 

[Aether2000]

Interesting since this was already settled by Roberts and the US Supreme Court.....

 

[Disciple]

Interesting since this was already settled by Roberts and the US Supreme Court.....

Brett Kavanaugh Isn’t the Real Threat to Obamacare. John Roberts Is.

 

[DODOCSS]

Interesting since this was already settled by Roberts and the US Supreme Court.....

 

[hyperalgesia]

Interesting since this was already settled by Roberts and the US Supreme Court.....

I also don't get it. SC won't hear the "mandate" issue again. Not that it matters. Ramming something so controversial through congress totally backfired. It gave us a completely Republican controlled govt. It gave us "Hitler". Hopefully people learned their lesson...

 

[emd123]

Interesting since this was already settled by Roberts and the US Supreme Court.....

Congress repealing the mandate is what changed since Roberts and the SC weighed in. That's the basis on which the judge claimed to take it up again. The whole law, without the mandate which underpinned the whole law itself.

If the idea that the whole law is unconstitutional holds, I sure as hell hope that means Obamacare's taxes stop being collected sooner rather than later.

Good riddance to this s**t law that ruined private health insurance for the majority of Americans

 

[SSdoc33]

I have no love for Obama care, but if the ACA goes away, it puts us that much closer to single payer. Democrats flipped so many seats bc healthcare is too expensive (and bc trump is worse than a peri rectal abscess, but I digress). Removing the mandate and headong toward ACA elimination will further bang the drum for Medicare for all. This will not help us

 

[Dr. Ice]

I have no love for Obama care, but if the ACA goes away, it puts us that much closer to single payer. Democrats flipped so many seats bc healthcare is too expensive (and bc trump is worse than a peri rectal abscess, but I digress). Removing the mandate and headong toward ACA elimination will further bang the drum for Medicare for all. This will not help us

Agree. Do we really think the American public is going to support being taxed up to 60% to pay for single payor though? I know the projection is somewhere along the lines of upto a 40% reduction in physician salary to help pay for it. I think the mandate being eliminated will not destroy the whole bill unless they really link overall lack of constitutionality to the entire thing.

 

[hyperalgesia]

Agree. Do we really think the American public is going to support being taxed up to 60% to pay for single payor though? I know the projection is somewhere along the lines of upto a 40% reduction in physician salary to help pay for it. I think the mandate being eliminated will not destroy the whole bill unless they really link overall lack of constitutionality to the entire thing.

I don't think the law changed enough so that it now violates our constitutional rights. I think it's more constitutional now, without the mandate, workable or not.

 

[Ducttape]

According to this ruling, it does violate our constitutional rights.

I still fail to see how the private insurance era was better for Americans as a whole. The rich and healthy got insurance, the poor and sick did not.

 

[bronx43]

I have no love for Obama care, but if the ACA goes away, it puts us that much closer to single payer. Democrats flipped so many seats bc healthcare is too expensive (and bc trump is worse than a peri rectal abscess, but I digress). Removing the mandate and headong toward ACA elimination will further bang the drum for Medicare for all. This will not help us

It does seem more likely by the day that the purpose of the ACA was to push the country into single payer. The vitriol that I hear on a daily basis from patients from all walks of life towards private insurance companies is telling. I think the current system is on its last legs.

 

[bronx43]

Agree. Do we really think the American public is going to support being taxed up to 60% to pay for single payor though? I know the projection is somewhere along the lines of upto a 40% reduction in physician salary to help pay for it. I think the mandate being eliminated will not destroy the whole bill unless they really link overall lack of constitutionality to the entire thing.

Or they will just fiscally stimulate and take on more government debt.

 

[hyperalgesia]

If we go to single payer like Medicare for All, we will continue to deal with insurance.

Medicare is already migrating to the HMO/ACO Advantage payment model. This is where the govt pays a company, for-profit or otherwise, a lump sum per enrollees. This migration to the Advantage model will undoubtedly accelerate with massive increase in enrollment.

It's probably a better model for population health than what we currently have. But there should be no illusions about dealing with insurances and preauths, etc. Those are a fact of life in population healthcare so get used to them.

 

[bronx43]

If we go to single payer like Medicare for All, we will continue to deal with insurance.

Medicare is already migrating to the HMO/ACO Advantage payment model. This is where the govt pays a company, for-profit or otherwise, a lump sum per enrollees. This migration to the Advantage model will undoubtedly accelerate with massive increase in enrollment.

It's probably a better model for population health than what we currently have. But there should be no illusions about dealing with insurances and preauths, etc. Those are a fact of life in population healthcare so get used to them.

Medicare advantage will not be tenable politically IF there’s a big increase in taxes. These plans are basically catastrophic coverage where there’s high co-insurance for most health care services. It’s great if you’re healthy, but it doesn’t cover jack s***. Without drastic decrease in the actual cost of care, none of these payment models are viable long term.

 

[VA Hopeful Dr]

Medicare advantage will not be tenable politically IF there’s a big increase in taxes. These plans are basically catastrophic coverage where there’s high co-insurance for most health care services. It’s great if you’re healthy, but it doesn’t cover jack s***. Without drastic decrease in the actual cost of care, none of these payment models are viable long term.

That's... that's not at all what Medicare Advantage plans are.

I see lots of people with this plan: Plan Details

 

[bronx43]

That's... that's not at all what Medicare Advantage plans are.

I see lots of people with this plan: Plan Details

This plan is better than what is offered in my county (which covers a lot less), but still isn't great. A lot of the cost is still pushed onto older individuals on fixed income.
Let's break it down.

If you get admitted to the hospital, your first 6 days would run you almost $1800. Unless you get re-admitted within certain timeframe, this appears to reset each time until you hit your max out of pocket.
If you need any diagnostic testing other than a EKG, it's $295 copay.
If you need radiation therapy, it's 20% co-insurance.
If you need an X-ray, it's $20 copay.
If you need an imaging test beyond that, it's $295 copay.
Any outpatient surgery is $295.
And depending on the fine print from the plan, certain copays aren't included in the calculation for "max out of pocket" cost.

So, basically it makes preventative services free, but everything else is expensive for most retirees. Great if you are healthy. Not great if you actually need health care.
Most of my patients have significant disease, and these MA plans really clean them out.

 

[VA Hopeful Dr]

This plan is better than what is offered in my county (which covers a lot less), but still isn't great. A lot of the cost is still pushed onto older individuals on fixed income.
Let's break it down.

If you get admitted to the hospital, your first 6 days would run you almost $1800. Unless you get re-admitted within certain timeframe, this appears to reset each time until you hit your max out of pocket.
If you need any diagnostic testing other than a EKG, it's $295 copay.
If you need radiation therapy, it's 20% co-insurance.
If you need an X-ray, it's $20 copay.
If you need an imaging test beyond that, it's $295 copay.
Any outpatient surgery is $295.
And depending on the fine print from the plan, certain copays aren't included in the calculation for "max out of pocket" cost.

So, basically it makes preventative services free, but everything else is expensive for most retirees. Great if you are healthy. Not great if you actually need health care.
Most of my patients have significant disease, and these MA plans really clean them out.

You and I must be reading this very differently.

Primary care visits are free. Not just preventative, but any time you see your PCP you pay $0.

All labs are likewise free.

$0 for 3 month if you mail order tier 1 which covers most of the drugs I common use in that age group - allopurinol, metformin, pretty much every ACE/ARB, toprol/coreg, amlodipine, HCTZ, crestor/zocor/pravachol, zantac, protonix, synthroid, fosamax.

Pretty much every other generic is going to run them also $0/month if done with mail order.

Specialist copay is $40, which isn't $0 but its not too bad either.

Outpatient surgery maxes out at $300.

Outpatient obs (which as you're well aware is becoming more and more common) maxes out at $300 as well.

Also, this plan has a yearly out of pocket max of just over 6k. Regular part B does not have an out of pocket max.

 

[Doctodd]

if only they could regulate hospital executive salaries....how many suits making 6 figures does each hospital need?

 

[bronx43]

You and I must be reading this very differently.

Primary care visits are free. Not just preventative, but any time you see your PCP you pay $0.

All labs are likewise free.

$0 for 3 month if you mail order tier 1 which covers most of the drugs I common use in that age group - allopurinol, metformin, pretty much every ACE/ARB, toprol/coreg, amlodipine, HCTZ, crestor/zocor/pravachol, zantac, protonix, synthroid, fosamax.

Pretty much every other generic is going to run them also $0/month if done with mail order.

Specialist copay is $40, which isn't $0 but its not too bad either.

Outpatient surgery maxes out at $300.

Outpatient obs (which as you're well aware is becoming more and more common) maxes out at $300 as well.

Also, this plan has a yearly out of pocket max of just over 6k. Regular part B does not have an out of pocket max.

I'm a specialist, so that's probably why our patients are affected differently. $40 (it's 50 in my county) for each specialist visit adds up quickly when one is on fixed income, and many seniors with health problems see multiple specialists. I literally have patients tell me every week that they can't come in because they can't afford the $50 copay.

Many of my drugs are specialty drugs, so it's more or less cost prohibitive.

My patients need more diagnostic testing (other than EKG), and each one is going to run them $295 and it adds up significantly.

The point I'm trying to make is that if the government is going to offer single payer and increase taxes, people are going to want and assume that it's universal coverage. There will be ire if taxes are 60+% and people still have to pay $1800 for a hospital stay and $300 for a CT.

 

[hyperalgesia]

I'm a specialist, so that's probably why our patients are affected differently. $40 (it's 50 in my county) for each specialist visit adds up quickly when one is on fixed income, and many seniors with health problems see multiple specialists. I literally have patients tell me every week that they can't come in because they can't afford the $50 copay.

Many of my drugs are specialty drugs, so it's more or less cost prohibitive.

My patients need more diagnostic testing (other than EKG), and each one is going to run them $295 and it adds up significantly.

The point I'm trying to make is that if the government is going to offer single payer and increase taxes, people are going to want and assume that it's universal coverage. There will be ire if taxes are 60+% and people still have to pay $1800 for a hospital stay and $300 for a CT.

Any changes to the system will result in apocalyptic outcry. If you killed off the Advantage plans, everyone who is happy with Kaiser would go bonkers also.

 

[bronx43]

Any changes to the system will result in apocalyptic outcry. If you killed off the Advantage plans, everyone who is happy with Kaiser would go bonkers also.

There’s outcry with the status quo right now. The easiest political route for the policy makers is to go universal coverage while forcing down prices and running up public debt.

 

[VA Hopeful Dr]

I'm a specialist, so that's probably why our patients are affected differently. $40 (it's 50 in my county) for each specialist visit adds up quickly when one is on fixed income, and many seniors with health problems see multiple specialists. I literally have patients tell me every week that they can't come in because they can't afford the $50 copay.

Many of my drugs are specialty drugs, so it's more or less cost prohibitive.

My patients need more diagnostic testing (other than EKG), and each one is going to run them $295 and it adds up significantly.

The point I'm trying to make is that if the government is going to offer single payer and increase taxes, people are going to want and assume that it's universal coverage. There will be ire if taxes are 60+% and people still have to pay $1800 for a hospital stay and $300 for a CT.

Medicare part B is little better - its 20% with no maximum. For some testing that's less, for some it will be more.

 

[SSdoc33]

the bottom line is that care costs too much. all of this "squabbling for the scraps at longshank's table" doesnt solve the problem. we have to go after the 1000 gorilla in the room.

pharma, device manufacturers, hospitals/excess administrators, private insurance and their huge middleman mark-up.

all of these need to have the fat shaved off.

if you can find me the political will to get this done, id love to see it. some actual nitty-gritty minutiae work has to be done, rather than a one size fits all solution. central gvt has proven time and time again that they dont have the chops to do it.

i think we eventually end up with a crappy public option that covers everyone, and then those with the means can buy better insurance with shorter wait times and brand name drugs. thats the easiest solution without having to change so many systems.

 

[hyperalgesia]

i think we eventually end up with a crappy public option that covers everyone, and then those with the means can buy better insurance with shorter wait times and brand name drugs. thats the easiest solution without having to change so many systems.

I agree but isn't that what Medicaid is supposed to be?

 

[lonelobo]

I agree but isn't that what Medicaid is supposed to be?

No because everyone does not qualify for Medicaid

 

[SSdoc33]

I agree but isn't that what Medicaid is supposed to be?

in a way. but medicaid really only covers the indigent, and if you have any money at all, you either need to pay for a good chunk of care yourself, or at least the excess balance.

im talking about free care for everyone. but that "free" care is limited to preventative care, birth control, peri natal care, generic drugs, long waits to see specialists, long waits for MRIs and elective surgeries. the general public will just have to swallow this pill. you cant have your cake and eat it, too. if you want the cadillac, you have to buy the cadillac.

 

[hyperalgesia]

in a way. but medicaid really only covers the indigent, and if you have any money at all, you either need to pay for a good chunk of care yourself, or at least the excess balance.

im talking about free care for everyone. but that "free" care is limited to preventative care, birth control, peri natal care, generic drugs, long waits to see specialists, long waits for MRIs and elective surgeries. the general public will just have to swallow this pill. you cant have your cake and eat it, too. if you want the cadillac, you have to buy the cadillac.

Is this plan going to replace Medicare?

 

[SSdoc33]

Is this plan going to replace Medicare?

yup.

no medicare, no medicaid.

jus this plan. call it: universal coverage or whatever, but eliminate all the distinctions, make a simple plan for everyone

 

[hyperalgesia]

yup.

no medicare, no medicaid.

jus this plan. call it: universal coverage or whatever, but eliminate all the distinctions, make a simple plan for everyone

It sounds like Medicaid For All.

If there are long waits for MRIs and the other things you mentioned, Medicare supporters are gonna freak. It would take actual bipartisan leadership in Washington. But I support in principal.

 

[callmeanesthesia]

It sounds like Medicaid For All.

If there are long waits for MRIs and the other things you mentioned, Medicare supporters are gonna freak. It would take actual bipartisan leadership in Washington. But I support in principal.

Sadly it seems like my Medicaid patients actually get some of the best overall care, especially considering the comorbidities. Probably unique to my area as Medicaid contracted out management to a private company, but I have less hassle than private insurance getting things authorized, it pays better than Medicare, and when I do need to do a peer to peer the call goes directly to an actual doctor, who I’ve generally found reasonable.

 

[VA Hopeful Dr]

It sounds like Medicaid For All.

If there are long waits for MRIs and the other things you mentioned, Medicare supporters are gonna freak. It would take actual bipartisan leadership in Washington. But I support in principal.

I do think we'll end up in a UK-type system.

Coverage for everyone that has long waits and restricted formularies. You want better, pay for it.

 

[SSdoc33]

It sounds like Medicaid For All.

If there are long waits for MRIs and the other things you mentioned, Medicare supporters are gonna freak. It would take actual bipartisan leadership in Washington. But I support in principal.

it'd be like medicaid, but worse and with more restrictions. but, it'd be free.

and yes, MOST people wouldnt be happy with it. but they would accept it b/c they dont have to pay for it. you want better coverage, show me the money.

 

[Gauss]

It sounds like Medicaid For All.

medicaid is highly state specific which will lead to medical tourism

 

[Gauss]

it'd be like medicaid, but worse and with more restrictions. but, it'd be free.

and yes, MOST people wouldnt be happy with it. but they would accept it b/c they dont have to pay for it. you want better coverage, show me the money.

with ACA and medicaid expansion most medicaid plans are managed care plans which are insanely restrictive, and profitable for insurers

 

[hyperalgesia]

it'd be like medicaid, but worse and with more restrictions. but, it'd be free.

and yes, MOST people wouldnt be happy with it. but they would accept it b/c they dont have to pay for it. you want better coverage, show me the money.

Actually I think most people would be ok with it if it's executed well. But any conflicts or issues will be magnified 10000% by the opposing party/media.

Maybe if a bipartisan group came up with a pilot with volunteer patients and they made it REALLY smooth...

 

[VA Hopeful Dr]

Actually I think most people would be ok with it if it's executed well. But any conflicts or issues will be magnified 10000% by the opposing party/media.

Maybe if a bipartisan group came up with a pilot with volunteer patients and they made it REALLY smooth...

Depends on how bare bones the coverage is

 

[Ducttape]

Is this plan going to replace Medicare?

there is a difference between providing care for the indigent/poor and providing care for the elderly and disabled.


in a pure medicaid model, the lower middle class is priced out of insurance. these are the people that the ACA was meant to serve. but since they do not have money and do not feel the entitlement that the upper middle class currently does, one does not hear about those who the ACA actually helped.

 

[hyperalgesia]

it'd be like medicaid, but worse and with more restrictions. but, it'd be free.

and yes, MOST people wouldnt be happy with it. but they would accept it b/c they dont have to pay for it. you want better coverage, show me the money.

Do you think this would be better than VA Care for All (obviously with a less toxic name)?. That is, the govt has clinics and hospitals with employed docs/pharmacy/labs/imaging to provide basic, free care for all. Within this system, no pre-auths, no insurance, no profit motivations. If you want better, you pay for it on the outside...

As a libertarian, this would be worth it to me if it means the private world would be basically left alone. No more threats from Medicare, completely market-based healthcare economy, outside the govt clinics. Instead of mandating every ER must take every patient, the govt has to provide urgent access for all.

 

[Doctodd]

Democrats flipped so many seats bc healthcare is too expensive (and bc trump is worse than a peri rectal abscess, but I digress). Removing the mandate and headong toward ACA elimination will further bang the drum for Medicare for all. This will not help us

Still pissed off, huh? I admire your stamina

 

[lonelobo]

How about that Stock Market

 

[SSdoc33]

Still pissed off, huh? I admire your stamina

well, i was going to just decide to start loving trump, but then i thought: no, that would be the stupidest thing any rational human being could do.

#threadjack

 

[Doctodd]

Love?...yea like a cancer patient loves their oncologist/chemo.

The world’s stock market, or ours? Wonder how a newly elected Democrat Congress factors in.

I voted for Trump for these reasons:
1. Not Hillary and not socialist(wants to decrease govt and is pro-business)
2. Decrease illegal immigration
3. Conservative SCOTUS picks.

Nothing has changed for me except the Kavanaugh ****show revealed Democrat corruption and deceit knows no bounds.

 

[lonelobo]

Let the WITCHHUNT continue, lmao

 

[Doctodd]

Let the WITCHHUNT continue, lmao

yea...go for it i say. Speaking of which, why does Congress need to force Trump to submit his taxes? Dont they have a buddy at the IRS who can leak them?

 

[lonelobo]

Trump Foundation agrees to dissolve under court supervision - CNNPolitics

 

[hyperalgesia]

I won't lie, Trump tests with some of what he says...

But I still feel like his almost extinct quality of not giving a **** what anyone thinks is useful to get some things done in a bureaucracy. Some problems can't be fixed with cotton balls.

Also we owe him for exposing the utterly corrupt mass media and also some outrageous **** at the FBI.

Trump knows the world of sleaze and exposes it in others like no one else can.

Aside from all that, I like most, not all, of his policies.

 

[Doctodd]

Only $2.8 mill? Seems like Trump ought to take lessons from the Clintons seeing how they apparently defrauded their foundation for between $400 million to $2.5 Billion.

Trump Foundation agrees to dissolve under court supervision - CNNPolitics

"An attorney for the charity, Alan Futerfas, called the attorney general's statement "misleading," saying the foundation had been seeking to dissolve since Trump's election in 2016.

Unfortunately, the NYAG sought to prevent dissolution for almost two years, thereby depriving those most in need of nearly $1.7 million," Futerfas said."

 

[SSdoc33]

Only $2.8 mill? Seems like Trump ought to take lessons from the Clintons seeing how they apparently defrauded their foundation for between $400 million to $2.5 Billion.



"An attorney for the charity, Alan Futerfas, called the attorney general's statement "misleading," saying the foundation had been seeking to dissolve since Trump's election in 2016.

Unfortunately, the NYAG sought to prevent dissolution for almost two years, thereby depriving those most in need of nearly $1.7 million," Futerfas said."

jesus christ. get a clue, dude.

NYAG prevented dissolution so that it could continue with the discovery phase of the investigation. so that it could expose trump's illegal activity. trump would not dissolve it on his own if there were no investigation.

this false equivalence with everything Clinton is laughable.

the clinton foundation provides disaster relief, fights global warming, and does things like vaccinate and feed kids in africa.

Clinton Foundation - Wikipedia

it appears to me that the trump foundation does 1 thing and 1 thing only: line his pockets.

Donald J. Trump Foundation - Wikipedia

im not saying the clintons are completely clean, but have a little perspective.