Obamacare

[Tissue issue]

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Predictions for the Supreme Court decision anyone??

http://opinion.latimes.com/opinionla/2012/03/poll-of-legal-experts-predicts-a-win-for-obamacare.html

 

[Path or bust]

Predictions for the Supreme Court decision anyone??

http://opinion.latimes.com/opinionla/2012/03/poll-of-legal-experts-predicts-a-win-for-obamacare.html

Can't wait to hear what they say. For the first time in history they will be making audio discussions available on the court website.

Predictions?
They will probably leave it mostly intact, they would put the court into serious legitimacy before an election otherwise.

 

[Enkidu]

Predictions for the Supreme Court decision anyone??

http://opinion.latimes.com/opinionla/2012/03/poll-of-legal-experts-predicts-a-win-for-obamacare.html

I think it will remain more our less unchanged. Although conservatives generally support small government, conservative jurisprudence tends to defer to congress, hence all of yet rhetoric about "judicial activism". the power to regulate interstate commerce is extremely robust and been applied to much more dubious situations than this, with the support of conservative justices. If they overturn the ACA they will have a serious problem of legitimacy as impartial judges during our current polarization, and I don't think that Roberts will allow that.

 

[2121115]

If they overturn the ACA they will have a serious problem of legitimacy as impartial judges during our current polarization, and I don't think that Roberts will allow that.

Umm... no.

 

[BU Pathology]

One of arguments against the affordable care act is that employers will drop their insurance plans and pay the penalty for not providing insurance. The argument is that it will cost them less to pay the penalty compared to the cost of paying for health insurance.

That has not occurred here in Massachusetts. In fact, since the law went into effect in 2006 there has actually been an increase in the number of people who have their health insurance provided by their employers. This increase is even more impressive since it occurred at the same time that unemployment increased. Unemployed people do not have an employer to provide insurance, so the anticipated effect would have been a decrease in the number of people with employer insurance.

An analysis may be found here, and there are other studies to support the fact that employers have not dropped their health insurance just to save money.
http://www.americanprogress.org/issues/2011/04/mvf_healthcare_mass.html

This is an economic argument, not a legal argument. However, the foundation of the individual mandate is an economic argument and the constitutional right of Congress to regulate commerce.

 

[LADoc00]

An insurance mandate is not even close to what we should be concerned about.

The BIG ELEPHANT in our room is bundled payments. This would likely be the end of private practice Pathology as we know it today.

 

[BU Pathology]

An insurance mandate is not even close to what we should be concerned about.

The BIG ELEPHANT in our room is bundled payments. This would likely be the end of private practice Pathology as we know it today.

The bundled payment issue is critical to pathology, but I doubt that will be mentioned in the Supreme Court arguments. I agree this is the issue to watch. As health care reforms progress, and accountable care organizations develop, nearly everything will be bundled payments. The analyses that I have seen equate this to current Medicare payments for laboratory services, the Part A transfer discussion.

This is a threat to our reimbursement more than a threat to our profession. Of course I understand that without adequate reimbursement there will not be a profession.

 

[Tissue issue]

Another interesting article, including mention of ACO's (i.e. bundled payments).

http://www.businessweek.com/article...lready-transformed-u-dot-s-dot-health-care#p3

 

[pxjx]

What is astonishing is how people think that the gov't has the answer to everything. Although, I agree our healthcare definitely needs an overhaul, I do not believe that the ACA is the answer. Think about it, gov't began to really get involved in healthcare in the 1960s and yet it still does not have the answer. In fact since then health care cost has gone up dramatically, while reimbursement has declined. Gov't is the problem not the solution. Not only do I believe it is unconstitutional, but it will be an economic disaster. There is no way this country will be able to afford it, especially given that we are involved in 2 wars (potentially more to come) and we give out foreign aid like it is no one's business. I think we should return to consumer medicine!

 

[Path or bust]

I think we should return to consumer medicine!

There is alot of truth to that.

It's not that government tries to increase costs, its just economics. When they get involved things will get more expensive.

Look at tuition and how that skyrocketed when FAFSA and loans came along.

Its a argument that Ron Paul makes all the time. Pharmacy and medical companies are not afraid to say, "We charge what the market will bear". If they can get $100,000 for that new mechanical heart or whatever and someone is willing to pay for it, why shouldn't they get it?

 

[Enkidu]

What is astonishing is how people think that the gov't has the answer to everything. Although, I agree our healthcare definitely needs an overhaul, I do not believe that the ACA is the answer. Think about it, gov't began to really get involved in healthcare in the 1960s and yet it still does not have the answer. In fact since then health care cost has gone up dramatically, while reimbursement has declined. Gov't is the problem not the solution. Not only do I believe it is unconstitutional, but it will be an economic disaster. There is no way this country will be able to afford it, especially given that we are involved in 2 wars (potentially more to come) and we give out foreign aid like it is no one's business. I think we should return to consumer medicine!

Whatever its faults, I think the ACA is definitely constitutional. Its purpose is to regulate interstate commerce, and the mandate is necessary and proper to do so. Everything else is partisan rhetoric.

 

[Arctic Char]

What is astonishing is how people think that the gov't has the answer to everything. Although, I agree our healthcare definitely needs an overhaul, I do not believe that the ACA is the answer. Think about it, gov't began to really get involved in healthcare in the 1960s and yet it still does not have the answer. In fact since then health care cost has gone up dramatically, while reimbursement has declined. Gov't is the problem not the solution. Not only do I believe it is unconstitutional, but it will be an economic disaster. There is no way this country will be able to afford it, especially given that we are involved in 2 wars (potentially more to come) and we give out foreign aid like it is no one's business. I think we should return to consumer medicine!

just to bring you up to speed, the war in Iraq is over.

 

[2121115]

They may reduce physician reimbursement, but that won't curb health care costs at all. Physician reimbursement makes up less than 10% of medicare spending. After they gut doctors, who will they blame then?

 

[pxjx]

The bundled payment issue is critical to pathology, but I doubt that will be mentioned in the Supreme Court arguments. I agree this is the issue to watch. As health care reforms progress, and accountable care organizations develop, nearly everything will be bundled payments. The analyses that I have seen equate this to current Medicare payments for laboratory services, the Part A transfer discussion.

This is a threat to our reimbursement more than a threat to our profession. Of course I understand that without adequate reimbursement there will not be a profession.

just to bring you up to speed, the war in Iraq is over.

Yeah you are right the war in Iraq is over, just like there were WMDs in Iraq. Lets not forget that Al Qaeda was also there before we invaded Iraq. Get real!!! In all reality it should not even be called a "war" since it is really a illegal occupation. War was never declared by Congress like it is supposed to be under the Constitution.

 

[pxjx]

Whatever its faults, I think the ACA is definitely constitutional. Its purpose is to regulate interstate commerce, and the mandate is necessary and proper to do so. Everything else is partisan rhetoric.

Please forgive me ignorance, but can you explain how the ACA is constitutional and how it regulates the interstate commerce. Why is the mandate necessary?

 

[Tissue issue]

My opinion (FWIW) is that the legal debate masks economic reality- many hospitals are virtually insolvent and need a bailout like the banks did a few years ago. Check out this quote from the Businessweek article link I posted above:

"The nation’s hospitals absorbed more than $39 billion in uncompensated care in 2010 and backed the health-care overhaul only after receiving assurances that the mandate would boost revenue by more than the cost of implementation. If the mandate—and its millions of new paying patients—goes away, much of the extra $170 billion in expected revenue wouldalso vanish."

The hospital administrators WANT this. Big business wants this too, so they can stop having to pay so much for employee benefits. I think this thing is coming, and is virtually unstoppable in some form (bundled payments, etc.).

 

[Enkidu]

Please forgive me ignorance, but can you explain how the ACA is constitutional and how it regulates the interstate commerce. Why is the mandate necessary?

well, the healthcare industry is something like a 1.2 trillion dollar industry. Congress has the power to regulate any industry that affects the stream of commerce between the states. There has never been any doubt that congress could regulate healthcare, its already been doing it for some time under the power to regulate interstate commerce. as for the mandate being necessary, all there has to be is a rational basis for congress to believe that it would regulate healthcare, which it has.

 

[yaah]

If this thread gets too political I am going to close it. Keep the discussion related, if you want to discuss the political issues involved, please use other forums.

 

[Torsed]

If this thread gets too political I am going to close it. Keep the discussion related, if you want to discuss the political issues involved, please use other forums.

Shut her down Yaah. Some monkey in Foggy Nutts, North Dakota blabbering about Iraq and WMD. What a waste of my life.

 

[Enkidu]

Shut her down Yaah. Some monkey in Foggy Nutts, North Dakota blabbering about Iraq and WMD. What a waste of my life.

I think this is a good forum to talk about the legal framework of the law in a nonpartisan way. I understand that the law itself is a political issue that people will have differing opinions on, but the question of whether the law is constitutional should be neutral. At least, we are entrusting the issue to a panel of 9 allegedly neutral justices to decide it.

As for bundled payments, if I understand this correctly, then it means that a fixed amount of money for a given patient's care will be divided among the physicians caring for that patient. The assumption is that the pathologists will have little to bring to the bargaining table, and so they will see a drop in compensation?

I guess that it would apply to pathologists in the sense that a misdiagnosis would result in wrong interventions and increase costs.

 

[WEBB PINKERTON]

Doctors, ourselves included, share some of the blame for making health care costs way too high. Think about all the waste you see just in the laboratory and it is supposedly only 2 percent of health care spending. Getting rid of client billing and in-office labs seems like an obvious way to lessen self referral and overutilization of tests. How to stop pathologists from ordering unnecessary immunos etc would be more tricky. If something isnt done, everyone will be paying 10,000 a year just on freaking health insurance. We are probably heading there anyways since women dont wanna pay 9 dollars a month for birth control and think insurance should cover everything. Hope they dont add perms, facials, pedicures and manicures. I would like them to add running shoes since I go through so many.

The salad days are over. If you are practicing now, make your money and GTFO. Unless I had autism, there is no way I would consider going into pathology nowadays. The future is VERY bleak unless you wanna be a large hospital or corporate lab scope monkey.

 

[Tissue issue]

Memo to all concerned- Supreme Court decision due at the latest Friday June 29. Interesting how legal experts/talking heads don't have a clue what the Court will do.

 

[BU Pathology]

The vote will be 5 to 4. The only issue is whether it is 5 to uphold the law, or 5 to against the law.

 

[deleted103644]

The vote will be 5 to 4. The only issue is whether it is 5 to uphold the law, or 5 to against the law.

Roberts won't allow it to be a 5 4 decision - it diminishes the court.

If his side is losing, he will switch.

If it looks like they are winning 5-4, I'm not sure what he'd do, but I am sure he will not want to go forward with a 5-4 decision.

 

[Torsed]

Yeah you are right the war in Iraq is over, just like there were WMDs in Iraq. Lets not forget that Al Qaeda was also there before we invaded Iraq. Get real!!! In all reality it should not even be called a "war" since it is really a illegal occupation. War was never declared by Congress like it is supposed to be under the Constitution.

Why don't you go down to Arlington and scream this nonsense? 👎

 

[Whiskeypunch]

It's pretty clear the mandate will be struck down. Mandating positive action (you have to go do something) is a completely unprecedented application of the commerce clause. It's never been used in this way and represents a dramatic increase in government power. That's what people were missing with the broccoli example. Obviously it's trivial and silly to compare broccoli to health insurance, but the whole point of the example is that if we read the commerce clause this way the government could make that a law.

The government could say if you don't exercise 30 minutes a day you go to jail. Reading the commerce clause to allow the mandate expands government power to allow it to pass those kinds of laws. The whole point of the constitution is to act as a limitation on government power.

The only way to make the mandate constitutional is to basically rule that this is a very specific and limited case and there are mitigating reasons for keeping the mandate, and this reading of the commerce clause can't be used to justify anything else. I don't think the court will do this. They will very very likely strike down the mandate.

The real wildcard is whether the court will decide the mandate is severable from the law. I think they will decide it is severable to save themselves the hassle of going through a mountain of a bill but who knows. There is a decent chance they could either throw the whole thing out or throw out the sections that are attached to the mandate (that's what Obama argued they should do).

Full disclosure I'm a liberal who wants universal healthcare.

 

[TMZ2007]

Mandating positive action (you have to go do something) is a completely unprecedented application of the commerce clause. It's never been used in this way and represents a dramatic increase in government power.

Never underestimate the desire of the federal government to expand federal power when it feels like it.

 

[rollwithit]

It's pretty clear the mandate will be struck down. Mandating positive action (you have to go do something) is a completely unprecedented application of the commerce clause. It's never been used in this way and represents a dramatic increase in government power. That's what people were missing with the broccoli example. Obviously it's trivial and silly to compare broccoli to health insurance, but the whole point of the example is that if we read the commerce clause this way the government could make that a law.

The government could say if you don't exercise 30 minutes a day you go to jail. Reading the commerce clause to allow the mandate expands government power to allow it to pass those kinds of laws. The whole point of the constitution is to act as a limitation on government power.

The only way to make the mandate constitutional is to basically rule that this is a very specific and limited case and there are mitigating reasons for keeping the mandate, and this reading of the commerce clause can't be used to justify anything else. I don't think the court will do this. They will very very likely strike down the mandate.

The real wildcard is whether the court will decide the mandate is severable from the law. I think they will just to save themselves hassle and say it is severable, but who knows. There is a decent chance they could either throw the whole thing out or throw out the sections that are attached to the mandate (that's what Obama argued they should do).

Full disclosure I'm a liberal who wants universal healthcare.

I understand the broccoli analogy and the difference between regulating markets and forcing one to enter one. The commerce clause allows the federal government to regulate interstate commerce, but it doesn't state that it has the power to force citizens to participate in a market.

Where I get hung up is when it's okay for States to compel individuals to buy a product when entering into a market or activity. Car insurance is the simple example. Many states require one to purchase car insurance as a condition of driving. I get that and don't have any problem with it because nobody forces me to become a driver. I have an alternative of taking the bus or walking. The purpose of requiring this is, of course, reducing overall costs for the market participants by not having to pick up the tab of the people that made bad decisions by wrecking their car and/or injuring other drivers and not being able to fairly compensate for their mistake via their insurance policy. Those costs are all passed on to the other market participants and the responsible people are the losers instead of the irresponsible parties.

Can you think of healthcare the same way? At first thought, I wouldn't think any government (state or federal) could force me to buy an insurance product as I don't willingly enter into a market or activity. But is that really an accurate statement? Every single one of us is going to require health care in some form or fashion at some point in our lives. And most of us are going to incur bills so high that we couldn't possibly cover the costs uninsured. It sounds ridiculous to say, but if a State can require us to purchase car insurance as a condition of driving, then why can't they require us to purchase health insurance as a condition of living?

Is this really a Federal vs State's-rights argument? Or have the States gotten this wrong and they shouldn't be forcing people to buy insurance in the first place?

 

[mlw03]

Never underestimate the desire of the federal government to expand federal power when it feels like it.

That's why we have a (supposedly) indepdent judicial branch. What's interesting to me is the articles I have read saying how it'd have been much simpler from the legal perspective to just go to a true single-payer type of system.

 

[rollwithit]

That's why we have a (supposedly) indepdent judicial branch. What's interesting to me is the articles I have read saying how it'd have been much simpler from the legal perspective to just go to a true single-payer type of system.

Yeah, but then it would have to be funded by a tax and not an insurance system. And we all know what happens when politicians get branded as those who bring about new taxes...they lose their jobs.

 

[TMZ2007]

That's why we have a (supposedly) indepdent judicial branch. What's interesting to me is the articles I have read saying how it'd have been much simpler from the legal perspective to just go to a true single-payer type of system.

I am actually referring to the judicial branch in this case; I've read several credible commentaries that argue that several of the "conservative" justices may vote to uphold the mandate because they are generally in favor of increasing the authority of the federal government (at least, as far as their recent rulings are concerned).

 

[deleted103644]

That's why we have a (supposedly) indepdent judicial branch. What's interesting to me is the articles I have read saying how it'd have been much simpler from the legal perspective to just go to a true single-payer type of system.

Yup. The current mandate is actually the conservative solution to universal coverage.

The liberal one is single payer.

 

[Thrombus]

Yup. The current mandate is actually the conservative solution to universal coverage.

The liberal one is single payer.

FYI: There is nothing "conservative" about single payer health care. Perhaps a liberal republican would advocate such a stance but most equate conservatives with a libertarian FREE market approach in terms of economics.

I personally would be all for a universal health care system if politicians were honest and trustworthy; and government systems efficient, accountable, and monetarily responsible. Unfortunately the inverse of all that is true nearly uniformly. 👎thumbdown👎mad:😡😡

 

[Prncssbuttercup]

I have family who live abroad, in the EU. They laugh about how we have a saying "good enough for government work" meaning it's poor quality, because if you said the same in their countries it would mean it was high quality. I agree with Thrombus that a single-payer system COULD work if we didn't have fraud at the very root of our government systems... The physicians I know in real life (who are my friends) all want a single-payer system. Their theory is that if they're going to get bent over by everyone, it might as well be only ONE person (system) bending them over, instead of 100. They also figure they're missing out on 30% of the potential clients that they may or may not have time to see...

 

[KluverB]

...I personally would be all for a universal health care system if politicians were honest and trustworthy; and government systems efficient, accountable, and monetarily responsible....

Can it really be any more inefficient than the current system?

 

[deleted103644]

FYI: There is nothing "conservative" about single payer health care.

I didn't say that. I said that the universal mandate was.

Perhaps you'd prefer to call it market-based rather than conservative, but once you accept the goal of universal coverage, it is the most conservative option.

 

[rollwithit]

I personally would be all for a universal health care system if politicians were honest and trustworthy; and government systems efficient, accountable, and monetarily responsible. Unfortunately the inverse of all that is true nearly uniformly. 👎thumbdown👎mad:😡😡

Count me in on that boat also. But don't forget about the consumer side. The American consumers of healthcare aren't reasonable people either. In our current system, the insured people treat it like prepaid services. We go to the Doc for anything and everything because, by golly, we paid for it already! We don't take care of ourselves to minimize our health care usage and we don't care about the cost of anything because a 3rd party pays for it. It's just like if our car insurance covered fuel and maintenance. If that were the case, we wouldn't ever self-ration our fuel consumption and would rag the hell out of our vehicles because it's somebody else's problem once that premium payment is made. That or there were an "emergency room" for broken down vehicles where we could get our cars fixed in a couple of weeks and just not pay the bill...

The only long-term sustainable solution is one where the consumer of medical services has a self-regulating mechanism to ration services for themselves. Otherwise, demand and prices for services are artificially high and we all lose. If any proposal for health care reform doesn't lead us down a path where we shift from a system where the consumer doesn't care about consumption to a path where the consumer is covered for catastrophic things but minor more routine things are their own responsibility, it's not a viable long-term solution.

Humans are an incentive-driven creatures. Give them an incentive (spend less money, keep more money) to ration their own health care by taking better of themselves and cutting out the BS they don't need (i.e. little Johnnie has a cough and needs a z-pack, this rash itches, my cholesterol is high because I'm obese/sedentary. etc.), and they will react. Don't give them an incentive to ration their own care and we get into the situation we are in now where it's becoming apparent most don't want to acknowledge these lack of incentives and think that the only option is turn it over to the government to let them ration it for us.

 

[yaah]

Based on the trend of the rulings lately, this ruling is probably not really going to be a true "5-4" ruling but more like a 3-2-2-1-1 ruling with five separate opinions where ultimately the short version is a 5-4 vote against it but lots of vaguaries and concurring and dissenting opinions so the end result ends up extremely confusing.

Kind of like Bush vs Gore where the initial opinion of the ruling was that it was in Gore's favor but after figuring out the different opinions it turned out it wasn't.

I mean, look at this for an example: http://www.theatlantic.com/national...s-apart-over-the-confrontation-clause/258634/ - Five justices essentially disagree with the final ruling. How is that possible? Ask a lawyer.

 

[scarshapedstar]

Based on the trend of the rulings lately, this ruling is probably not really going to be a true "5-4" ruling but more like a 3-2-2-1-1 ruling with five separate opinions where ultimately the short version is a 5-4 vote against it but lots of vaguaries and concurring and dissenting opinions so the end result ends up extremely confusing.

Kind of like Bush vs Gore where the initial opinion of the ruling was that it was in Gore's favor but after figuring out the different opinions it turned out it wasn't.

I mean, look at this for an example: http://www.theatlantic.com/national...s-apart-over-the-confrontation-clause/258634/ - Five justices essentially disagree with the final ruling. How is that possible? Ask a lawyer.

tl;dr the wingnut judges vote to appease their corporate cronies and make up whatever reason they feel like, even if it violates precedent and especially if it requires another Bush v Gore style 'don't hold us to this ruling in the future, yes, we know it's laughably hackish' no-precedent clause.

 

[pathstudent]

Hopefully they will completely reject it. WSJ had a recent piece detailing how obama was in bed with the pharmaceutical companies during the write up of this law.

They would stand to make billions at our expense.

Docs would take a beating as we are not 1/100 as powerful as drug companies and hospital corporations (owned by connected families like the Frists).

I hope it is struck down with maintenance of FFS and CPT codes with expansion of medicare coverage but with rationing of healthcare (i.e. death panels - the next time a 75 year old gets a GBM they will be sent home to die a peaceful death 6 months from now, rather than undergoing surgery, prolonged hospital stays, radiation and chemo to die 12 months from now)

 

[deleted103644]

Hopefully they will completely reject it. WSJ had a recent piece detailing how obama was in bed with the pharmaceutical companies during the write up of this law.

They would stand to make billions at our expense.

Docs would take a beating as we are not 1/100 as powerful as drug companies and hospital corporations (owned by connected families like the Frists).

I hope it is struck down with maintenance of FFS and CPT codes with expansion of medicare coverage but with rationing of healthcare (i.e. death panels - the next time a 75 year old gets a GBM they will be sent home to die a peaceful death 6 months from now, rather than undergoing surgery, prolonged hospital stays, radiation and chemo to die 12 months from now)

Are you a conservative making a liberal argument to spite Obama, or a liberal being consistent?

 

[scarshapedstar]

Hopefully they will completely reject it. WSJ had a recent piece detailing how obama was in bed with the pharmaceutical companies during the write up of this law.

Did they mention the $150,000 that the insurance companies gave to Clarence Thomas's wife?

 

[Tissue issue]

Well here comes the decision............ the wait is FINALLY over!