Congress, Constitutional Law, Courts, Politics

Federal Appellate Court Strikes Down Obamacare’s Individual Mandate

I have long been critical of the individual mandate under the Affordable Care Act or Obamacare (See, e.g., here and here and here). Yesterday, the Fifth Circuit Court of Appeals handed down a major 2-1 ruling striking down the mandate as unconstitutional. The litigation however will continue over the viability of the rest of the Act without the individual. As discussed in an earlier column, pulling out the individual mandate creates a Jenga-like dilemma for the courts.

As I previously discussed last December, U.S. District Judge Reed O’Connor of the Northern District of Texas ruled that the individual mandate was unconstitutional and, using the Obama Administration’s own words, so essential to the Act that the entirety of the ACA had to be struck down.

In the decision below, Judges Jennifer Elrod and Kurt Engelhardt ruled that “[t]he individual mandate is unconstitutional because it can no longer be read as a tax, and there is no other constitutional provision that justifies this exercise of congressional power.” However, the panel significantly did not sign off on the striking down of the entire Act. It stated “[o]n the severability question, we remand to the district court to provide additional analysis of the provisions of the ACA as they currently exist.” The panel did not offer any insights in how that severability analysis would conclude: “It may still be that none of the ACA is severable from the individual mandate, even after this inquiry is concluded. It may be that all of the ACA is severable from the individual mandate. It may also be that some of the ACA is severable from the individual mandate, and some is not.” This leaves other important provisions in jeopardy, including sections dealing with preexisting conditions as well as subsidies and the expansion of Medicaid coverage.

The panel called the Supreme Court to account as did the district court. Chief Justice John Roberts saved the mandate by calling it a tax pursuant Congress’ taxing powers under Article I of the U.S. Constitution. Id.; U.S. Const. art. I, § 8, cl. 1. A majority of justices, including Roberts, agreed that the provision would otherwise be unconstitutional under the Commerce Clause because it would have done more than “regulate commerce . . . among the several states.” U.S. Const. art. I, § 8, cl. 3. Congress however later killed the tax aspect of the mandate, exposing the mandate and the Act as a whole to this challenge.

This is a middle option between agreeing to strike down the entire Act or simply upholding the Act. It will allow a period of transition before any final decision is rendered if Congress wants to act.

The panel broke along ideological lines. The liberal member, Judge Carolyn King, disagreed with her two conservative colleagues. She held:

“I would vacate the district court’s order because none of the plaintiffs
have standing to challenge the coverage requirement. And although I would not reach the merits or remedial issues, if I did, I would conclude that the coverage requirement is constitutional, albeit unenforceable, and entirely severable from the remainder of the Affordable Care Act.”

The decision will rekindle calls for Congress to address the possible void in health care coverage. Republicans have long argued that Act was flawed (which it is) and that it can be replaced with a more tailored and constitutional alternative. President Donald Trump has pledged the same thing. That moment may now be here.

Nothing will happen immediately and the any decision could be delayed beyond the 2020 elections.

A coalition of states, led by California Attorney General Xavier Becerra, is pledging to file for review by the Supreme Court to overturn the Fifth Circuit.


Here is the opinion: Texas v. United States

150 thoughts on “Federal Appellate Court Strikes Down Obamacare’s Individual Mandate”

  1. That was Romneycare and the republicans plan since Gingrich,if anyone even cares.

    Democrats wanted single payer healthcare and we got the republicans plan.

    Forcing people into the for profit healthcare system into buying insurance policies that have high deductible and co pays is just a scam to steal.

    I know people who are paying for healthcare and can’t even afford to use it because they have a $4000 deductible.

    Thanks Obama!

    1. SteveJ:

      Remember that nifty math trick I showed you.

      You’re doing it. Relying on percentages instead of total dollar increase in order to misrepresent the affordability of insurance.

      1. I’ve already explained this to you. The rate of increase continues unless something is done to slow it down or stop it. If you think coverage was affordable in 2001 and was not significantly cutting into the ability of businesses to operate, you are deluding yourself. And it was increasing by more and more absolute dollar amounts by the year. That’s what the rate of increase means.

        You will have to recognize the reality of the situation that existed in 2001, borne of decades of people twiddling their thumbs — or not recognize it, which seems to be your preference.

        1. “The rate of increase continues unless something is done to slow it down or stop it.”

          Do we pay the same today as we do a cup of coffee in the 1920s?

          No. We do not.

          Although, in a way, insurance does lead to price increases in a similar mechanism that the proliferation of student loans led to tuition increases.

          If no one had insurance, then the vast majority of people could not afford an $80,000 short hospital stay. Doctors and hospitals could only charge what people would pay. The limit of what the market could bear would do exactly what you want – do something about the high cost of health care.

          The problem is that there is no real free market in health insurance. The insured doesn’t care if their knee surgery costs $60,000. They care about what they pay, and really could care less what the insurance company pays. The more insurance money is available, the higher prices tend to climb. Then some of those costs get passed on to consumers.

          This is one of the arguments used for single payor. They think it’s cutting out the middle man, but it’s not. Instead, it inserts a different bureaucratic middle man who could care even less about consumers. That bureaucracy has access to taxpayer money. It’s unelected. It could care less about efficiency. (Ask the VA). It could care less about customer satisfaction.

          The advantage of removing insurance entirely is that it keeps costs down. The disadvantage is that those costs drive innovation. It takes 10 years and millions of dollars to get a new drug through the FDA. Most fail. For every drug that succeeds, it has to pay for not only its own R&D and QC testing, but also for all of the many failures that came before it. Then it’s got to fund the R&D for the next new drugs in the pipeline. Remove insurance money, and that research money dries up. In fact, the single payor healthcare systems don’t pay their fair share. They benefit from all the new medications and treatments that America develops. But they don’t want to pay for it.

          If you remove insurance, then there will be medical procedures that cost too much for the average person to afford.

          So, there is a quandary. Insurance drives up medical costs. Single payor inserts a bureaucracy between patient and provider, creates sloth, wastes taxpayer money, and it always rations healthcare. It creates infamously long wait times, and the bureaucracy can prevent you from getting care. If it deems you “too old” or otherwise unfit, it will not allow you to receive certain care. There was just a terrible scandal in UK where parents of a child with a genetic defect wanted to take their baby to the US to try an experimental treatment that might save their child. The UK denied their request, and they were not permitted, by law, to remove their child and seek other care. They had given their government that power of choice over the most intimate part of their lives.

          Since I agree that health insurance in general contributes to rising costs, but dislike single payor for the reasons given, that leaves us with a few options.

          I found my previous insurance affordable and my doctors accepted it. The premium was only a couple hundred or so a month, and the deductible was $500. It was accepted everywhere. The copays were reasonable. It was a PPO, and covered everything I needed. It was not a catastrophic policy. I was happy with it.

          We could go back to that.

          Other options include having catastrophic plans that would pay for serious and expensive care, and paying out of pocket for everything else. There would need to be a plan available for the poor to cover that out of pocket costs.

          Health Savings Accounts are helpful. There are other ideas I’ve got bookmarked but I won’t spend that much time pulling them out now.

          There needs to be more of a market pressure on health care spending. With insurance as the middle man, patients don’t care about cost, so they don’t shop around like they do for other major purchases, such as for cars or houses. We need to improve the FDA process, while maintaining safety.

      2. By the way, I don’t dispute that health care coverage is less affordable now than it was in 2001. Employer premiums increased by 54%. I simply note that that is better than 166% which happens if you don’t do anything.

        I think Republicans can come up with a better plan than the current one. They have had decades to do so. So let’s have it.

        1. Don’t hold your breath SteveJ. The GOP doesn’t care about this issue except at campaign time when the empty promises flow like health industry lobbyist money at the Old Ebbet Grill.

          This problem is not rocket science, or the rest of the world wouldn’t be doing it at 60% of what we pay, and with universal coverage.

          1. Again, total ad hominem against the GOP. You actually believe that half the country could care less about the cost of health care or the poor? Then you’re willfully blind.

            What’s it like in the rest of the world? Languishing in wait times. Becoming addicted to pain medication because it takes so long to get surgery. Dying over the weekend because the DMV like nursing staff neglects you. Paying out of pocket for concierge care or flying to the US to skip the long lines.

            So many European and Canadian celebrities have done exactly that – flown to the US to get immediate care for themselves or their kids.

            Let’s look at Canada, shall we? Canadians are used to their single payor care. They’ve paid into the system, and by golly, they want to get the benefit of it. How’s it stacking up?

            For one, there are constant headlines that their healthcare system is unsustainable, and every dime they tax will eventually go to healthcare.

            https://www.huffingtonpost.ca/natasha-macdonalddupuis/the-future-of-canadian-healthcare_b_4429892.html

            “A little over 2 months ago, the Society of Actuaries and the Canadian Institute of Actuaries released their “Sustainability of the Canadian Health Care System and Impact of the 2014 Revision to the Canada Health Transfer,” report, outlining the viability of our health care system over a 25-year horizon. While the report seemed to slip under the media radar, the results are nonetheless daunting. Actuarial analysis of the Canadian health care system concludes that, at current growth rates, a staggering 97 per cent of total revenues available to provinces and territories will be spent on health care expenditures by 2037, compared to 44 per cent in 2012.”

            http://www.city-journal.org/html/ugly-truth-about-canadian-health-care-13032.html

            “My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.”

            Politicians lied to get Obamacare passed. They’re lying about single payor now. Bernie at least admitted that it would raise taxes on the middle class, and even then, he’s only gotten about half of it paid for. Elizabeth Warren is still claiming that taxes won’t go up. She keeps thinking she can shake that rich people’s money tree, they will endlessly pay for everything, over and above their total net worth, but they will dutifully keep employing people, keep their companies running, even though it’s not worth it financially.

            Politicians need to be honest about single payor. It will cost more. Everyone’s taxes will go up, except the poor who don’t pay taxes. There will be more unemployment as those higher taxes cost jobs. The waiting times to be seen will be so long that people will wait for days in the emergency room, and months and even years for surgery. In order to get the best care, they will still need to pay out of pocket for some sort of concierge system like they have in Canada.

            Just, be honest. If it passes, then that’s what voters want. What I can’t stand is the way that politicians lie, and their voters just eat it up. Years later, there is still this incredible pushback that Obamacare didn’t raise costs. It’s absurd.

            1. Karen, who regularly denounces democrats without differentiating is calling me out for an ad hominem on the GOP? Poor baby! I think it was clear I was speaking about GOP politicians since I referenced campaigning. If she thinks they do care, where’s the beef?

              Karen apparently does not realize that medical tourism includes Americans going elsewhere for care and in greater numbers than those coming here.She also apparently does not know that we rank middle of the pack in both health care results and patient satisfaction. That means we also wait and then pay through the nose. She also seems to not know that the rest of the world addresses the problem in a wide variety of ways including socialized medicine (the UK) and mixtures of private and public insurance with non government providers (France and Germany). The unifying principle which makes them all cheaper, is the government negotiates prices with providers. Well find our way eventually. We’ll have no choice. We can’t afford our system.

              1. “Canada’s health-care wait times eclipsed 20 weeks in 2019; second-longest wait ever recorded”

                https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2019

                They have one of the better systems and they can go to the US for care. In fact there are companies that help Candadians get important health care in the US.

                The US does outsource a lot of healthcare to foreign nations. Plastic surgery is a big one. Costa Rica is a nice place for a face lift and a vacation while the healing takes place.

                1. Allan – plastic surgery is cheaper in countries with a lower cost of living. It takes less money to live well, so they charge less. There are also lower standards.

                  Costa Rica has a lot of American ex pats. I would not get any sort of elective surgery anywhere outside of a first world country. Vacation in Costa Rica, yes. Elective surgery, no.

                  I know of people who couldn’t get into medical school in the states, so they went to other countries to go to school. Often it was the Caribbean. Then they return to the states to practice medicine. They are not the best doctors one could find.

                  Medications are often cheaper in other countries for many reasons. There are different patent laws. Countries have price caps. We pay for the R&D, while the other countries pay lower prices. The manufacturer can afford to sell it at a lower price elsewhere because the US pays a higher price. We have the FDA. Sometimes medications have not gone through the approval process here, or they have not been granted an off label use here.

                  I wouldn’t take any medication manufactured in China or Taiwan. That might become a problem for prescription drugs sold here in the US. Pharmaceutical companies are following the trend of out sourcing some lab work and even manufacturing active pharmaceutical ingredients (API). The results have been quite poor in some cases. It’s utter madness to outsource intellectual property, which will be stolen, and manufacturing, in countries infamous for fraud and contamination. I don’t think the new agreement allowing the FDA to inspect offshore facilities is going to cut it.

                  1. “Allan – plastic surgery is cheaper in countries with a lower cost of living. It takes less money to live well, so they charge less. There are also lower standards.”

                    That is true, but the fact is that Americans do travel to other countries for these high priced cosmetic fixes. At the same time many of our western friends travel abroad for major necessary surgery that they cannot get in their own country. Look at the wait times in Cananda that I posted recently.

                    The question is who will decide what medical care we are able to get, state or individual care. Either way the citizens pay. Private insurance works very well for the individual, however the government involved itself after WW2 in making it tax deductible and from then on created two classes of citizens, one with employer insurance that was tax deductible and one without the deduction. We either need to get rid of the tax deduction or make all equal.

                    Because of the tax deduction health insurance increased its coverage and decreased its deductible. Those types of actions increase the costs of healthcare and lead to the sickest sometimes not getting the care they need. Because of the tax deduction government felt the need to enter the business of health care. We have not had a free market in health care since WW2 and it has relied on government intervention more and more with ever increasing costs and ever increasing bureaucracies. There are loads of fixes that are possible but our policians on both sides act on behalf of themselves rather than on behalf of the people.

                    The left will constantly say people are going to die but they are actively killing people with their “kindness” so what they are really after is power and control. They wish to tell you what to do and perhaps how to vote. Health care can be used as a lever to provide them with more power. There is no problem with subsidies that are the least destructive to a market system. There is no problem with supporting those in need. The health care solution is rather simple but then what would those that desire power do if power was taken away?

              2. bythebook:

                No matter what name you write under, you behave the same. Same name calling. Same tenor.

                I have pointed out valid Democrat strategies that I disagree with. I don’t call Democrats vile names. I list what I have a problem with, specifically.

                It is an acknowledged truth that the Democrats have gone farther Left. It’s hardly deniable. They have put up multiple openly socialist candidates. Socialism is an inherently unjust system that leads to deprivation and human rights abuses. Of course I oppose this direction.

                It is a long-standing truth that Democrats have been calling Republicans evil names when they oppose policies.

                Professor Turley has written numerous blogs on the nation wide harassment of conservative students and invited speakers.

                Then there’s Antifa. Open Borders. Anti Trump and Trump voter mania. The harassment and violence of people wearing MAGA hats.

                No one can deny that identity politics is a Democrat phenomenon. You are judged based on race, gender, and sexual preference. That is racism, gender bias, and sexuality bias.

                It is a fact that Democrats have pushed an anti-white, anti-male, and anti-cis gendered strategy. That’s bigoted, and I’m not interested.

                It is a fact that Democrats have reduced being a woman to a simple declaration. A man can be a woman at any given moment, then a man, then a woman… Democrats have pushed to give men access to women’s bathrooms, showers, changing rooms, battered women’s shelters, and sports divisions. Anywhere that was carved out to give women their own space, for their privacy, safety, or for them to enjoy sports, has been given to men. All they have to do is declare they are a woman to get the keys. As a woman, obviously I oppose that. Democrats attack those who apply the scientific definition to sex, and the mental disorder of gender dysphoria, calling them transphobic. Again, it’s attack, not discuss. That is off putting.

                These are facts.

                I have become hardened against the Democrat Party because I do not support what they stand for. These aren’t false allegations but provable facts. I have no problem with moderate Democrats, but they appear to have gone underground.

                I don’t think that Democrats don’t care about people or are inherently evil. They suffer from Avenging Angel syndrome. I believe that they think they are helping. They are doing terrible things, believing in their heart that they are guardian angels or heroes. They are terribly misguided, but they are not evil, on the whole.

                I don’t want Democrats to suffer along with everyone else if they create yet another Leftist dictatorship.

                The problem is that politicians have convinced too many Democrats that Republicans are evil. Therefore they deserve to be treated in a vile manner.

                That is why, here on the blog, when I point out the factual problems with Obamacare, the response is, oh, you don’t want the poor to get health insurance. That’s false logic, and a strategy to paint your opponent as morally wrong, when you cannot dispute their facts. It’s a dirty trick, and it’s gotten old.

                1. The problem with the Democratic Party is not that they’ve ‘moved left’. It’s that they are a criminal mafia whose raison d’etre is inflicting injuries on social subsets outside their client list. Street-level Democrats are content with that. Which is one reason, among others, that things may get very ugly in this country quite soon. I bet China is salivating over the prospect.

                  1. Which is one reason, among others, that things may get very ugly in this country quite soon.

                    You remind us regularly. And Ive asked you in the past what you are doing about it.

                    You blame the Dems for everything. You’re heavy handed with blaming whatever group you find offensive to your contrived and bogus sensors. What do you propose as a solution other than kvetching about it as much as you do?

                    It it 27 degrees F outside, I woke at 5 am, just finished my cardio routine at the university medical center gym, and have a full day ahead of me. Yet here you are again in the early morning hours being doom and gloom about x, y and z groups even if youre rather young. That you fail to see your own pathology is telling.

                    I was assigned a patient earlier this year who has Cerebral Palsy. She/he is greater than 25 yr but less than 55. Whenever I visit her/him at the residential facility where she/he was placed decades ago by their parent, the patient is busy interacting with other residents, staff members or writing on their blog….with one working hand from a fixed iPad attached to their motorized wheelchair. Months ago she/he asked me my thoughts about their volunteering as a greeter at the university hospital. The suggestion took me aback, because I knew where this was going. Upon reflection I said, “I love the idea but are you sure you can so this?” Fast forward a few months, the patient is religiously working the facility drivers, staff members and others to transport them to the hospital once a week to be a greeter in a hectic university hospital lobby to greet patients and visitors to the hospital. The person’s speech is barely intelligible. Their movements are almost nill except for that one hand that has some movement to control their wheelchair. And yet, for her/him, she/ he is in heaven.

                    I mentioned recently we have a friend who is dying from Amyotrophic Lateral Sclerosis. But dont tell him/her that. She/he has bible studies, speakers, nursing staff, friends and neighbors visiting at their home but here is the rub. The person with ALS is inspiring others. She/he knows death is around the corner but there isnt a frown, a dejected spirit, an doom and gloom disposition. No, the ALS is not keeping their spirits down because she/he believes in their heart of hearts that there is work to do in this world, and she/he is going to do their part in the best way they can

                    So spare us your doom and gloom, your prognostic powers and your infinite wisdom of separating the sheep from the goats. Whether you are confined at home, incapacitated, or have a mental issue (we all have mental issues), do the world a favor: spread some good cheer, do good works even if its within the restraints of a wheelchair, sucking on a breathing tube gasping for air because your diaphragm and lungs cant contract due to ALS. You can do better

                    What you do today is your gift to God considering God has gifted you with His love. Out-do Him

                    Ad Majorem Dei Gloriam

                    1. I don’t live in any world but his one, and I have to make the best sense of it I can.

                      One aspect of my particular social world is the aggression of social segments and cultural dispositions contra everyone else. I live in the world that is, not in your fanciful world. In the world in which I live, this aggression is pretty well unidirectional. Go back 50 years, and that wasn’t precisely the case. Well, 1966 was a while ago, in my lifetime and yours.

                      Since I allocate a certain number of pixels arguing with people promoting catastrophe scenarios (mostly monetary cranks) and – uh – inventive conspiracy scenarios (mostly Kennedy assassination cranks), I find your assessment of my person pretty amusing.

                2. Karen, I did’t call you a name nor did I imply you were vile, though I did imply GOP politicians are for pretending to care about health care but doing nothing about it. I implied you are hypocritical for crying about imagined slurs on every Republican – my comments were clearly aimed at politicians – when that is exactly what you do regarding democrats, every day and in most posts. This is the kitchen, there’s the door. You you know how to get out? I also said that you seem ignorant about what works to make health care cheaper EVERYWHERE ELSE IN THE WORLD, with no obvious dimuNition in service and certainly better coverage.

                  I am a tenor. How could you tell?

        2. Are you still saying that removing all those copays in Obamacare made no difference in the rate of increase? Did you read any of the links I posted? Please explain the math, how you can add required coverage, remove copays, but Obamacare did not cause any increases than would otherwise occur.

          Please review that math trick I explained about the percentage increases hiding the astronomical dollar increases. Once they jacked up the deductibles from $500 to $6,000 then $12,000 then $12,600, increases looked like smaller percentages, but the annual dollar amount increases were more than the entire annual deductibles people used to pay.

  3. PUBLIC IS NOT ENTIRELY AWARE..

    OF EVERY PROVISION IN OBAMACARE

    If the A.C.A. is thrown out, people will be shocked by how much is gone. Didn’t pay a copay for your kid’s vaccine or your colonoscopy? Are you a senior with high drug costs that suddenly went from not covered to covered? That’s the A.C.A. Got new coverage for substance-use disorder treatment? That’s most likely the A.C.A., too.

    There’s much more: subsidies for about nine million Americans that have helped them obtain health care for the past six years. The Medicaid expansion, which has allowed roughly 17 million more Americans to get health care. Those with pre-existing conditions — as many as 133 million of them — who before the A.C.A. had to pay more or couldn’t get covered. All gone.

    The average American may not realize it because the decision was paused pending appeal, but the consequences of eliminating the health law will be staggering.

    Did Congress vote for these enormous disruptions to millions of Americans’ health care? Of course not. Americans would have known if that had happened. Republicans in Congress tried to repeal the law more than 60 times but failed because too many constituencies depend on the law and want it to stay. And yet the legal doctrine that the judge used to kill it is one that is supposed to turn on what Congress wanted and what Congress did.

    Instead we had a federal judge who took matters into his own hands and decided to accomplish himself — ending the Affordable Care Act — what Congress decided it could and should not accomplish through the democratic process.

    Edited from: Who To Blame If Your Healthcare Is Lost”

    Today’s New York Time

    1. Phillip:

      Most of the public is not aware that their employers pay most of the burden of Obamacare, and that it did not affect them like it did individual policy holders. Not yet.

      If everyone had an Obamacare individual policy, there would be riots in the street. There would be no more ridiculous accusations that if you don’t like Obamacare you don’t like poor people. They would have gotten this monstrosity thrown out.

      If you told them, they could go back to their $500 deductible, down from the $12,600 Obamacare deductible, do you think they’d honestly care about a $5 vaccine copay? Get serious.

      Perhaps enough people will persist until they get single payor, and they lose those employer policies. Who knows.

      Remember when Obama told us Obamacare was not a tax? And then his lawyers told the Supreme Court that it was a tax. That’s how they got it through. This court judged that it was not a tax, “using Obama’s own words.”

      Again, why is a $12,600 deductible OK? Would you be willing to pay $1200 a month, plus $12,600 deductible for a policy that none of your doctors accept, and many top cancer treatments centers won’t accept? Because if you would not want that, stop enabling this to be forced upon others.

      Obama deliberately lied to get this through. For that reason alone, it should have been immediately repealed. It’s not right to tell bald faced lies to get something to pass. Its chicanery.

      1. How can both of these statements be true:

        Under Obamacare, deductibles rose from $500 to $12,600.

        Obamacare did not increase your healthcare costs.

        You keep denying the facts that Obamacare is unaffordable. Many politicians admit it now. AOC admits it. They just won’t admit it’s their fault.

        Health insurance used to be affordable for many people. Now it is unaffordable for the unsubsidized middle class.

        I’ve already explained the difference between percentage and total cost.

        In the private market, if the insurers jacked up their deductibles this much, people would not voluntarily buy their products. Obamacare took away the ability to have different plans. Obamacare is all the same plan. It has slightly different premium and deductible among the three tiers. It has a different insurer’s name on it. But it’s all the same plan.

        In the private market, if an insurer offered a plan that cost $1200/month, with a $12,600 deductible, but many doctors did not accept it nor most cancer treatment hospitals, because it didn’t pay them enough, and there was an open market with myriad other choices, how many of those plans do you think they would sell?

        Now, people have to buy those plans. There are no other options. They are all the same plans, all the same relative costs. And if you don’t buy it, you’ll be fined.

  4. Democrats typically accuse Republicans of being immoral when they hold cost considerations to be important.

    OK. If a new law is going to affect you, who would you want crafting it? The people who claim the sky’s the limit, and who cares if it actually works or what it costs the taxpayers, i.e. you, or do you want the people who say no matter what, it has to work and this has to be affordable for taxpayers, i.e. you.

    Be honest, people.

    1. Well that isn’t the choice I was given. I was given a choice between doing something and a party that did nothing.

      For half of Bush’s presidency, the Republicans had the House and the Senate. What did they come up with? Zip! (Other than Medicare Part D of course) They weren’t interested.

      1. So, you’ll take something over nothing even if that “something” is blatantly unconstitutional…just because it benefits you. Lovely.

        1. Well if they keep the mandate with a penalty, it’s a tax. The Democrats seem to be fine in getting rid of it. They’ve already reduced the penalty to zero. So if they get rid of the mandate, there is no mandate. I think it’s a pretty risky move. But that’s what’s going to happen.

          1. If there is no mandate, and preexisting conditions are covered, then why would anyone buy insurance that expensive? IF they got rid of open enrollment requirements, people could wait until they had a major catastrophe, then apply for insurance in time to use the benefits, then cancel it when they’re done. If you don’t force people to buy this unaffordable insurance, then people won’t buy it. This will be more common among healthy people. The system will collapse on its own.

            Most people want preexisting conditions covered. That is the one single thing I can think of that I like about Obamacare, which stacks up to 6 feet tall. However, that’s not “insurance.” That’s really cost sharing, and we shouldn’t call it insurance.

            You can’t call a car insurance company, tell them you totaled your truck last week, and you want to buy insurance so you can get it fixed. You can’t cancel it right after it’s been fixed, and expect to do the same cycle next time.

            Frankly, I think we need to get rid of the insurance nomenclature and approach this as cost sharing.

      2. We were better off before Obamacare. Repealing it with no replacement at all would be an improvement.

        Politicians should have concentrated efforts at improving the quality of health care of the poor. It’s not insurance that matters. Obamacare is insurance, but it’s unaffordable and the good doctors don’t accept it. Therefore, although it’s a shiny new insurance card, it does not represent high quality health care.

        Target efforts on the poor.

        Don’t destroy health care for the middle class individual policy holders. That’s immoral.

        Republicans were caught flat footed, and without the will to just repeal the damn thing. They didn’t agree on what to replace it with, and lost their opportunity entirely. McCain ran on repealing Obamacare, but when he had the chance, he betrayed his voters. He’s passed away now, and his opportunity to make amends is over. He spent his time fighting with Trump, even dragging it out to his very funeral. Meanwhile, people on Obamacare with cancer can’t get access to top care. That was thoughtless. His fight’s over, and I hope he found peace.

        The whole “we must do something” argument holds no water. If you have termites, you could set your house on fire, and defend the action with, “well, we must do something.” Sure, you have no more termites, but you also don’t have a house.

        Bush did have a Health Care Agenda. He did not take away millions of people’s insurance, and he didn’t cost me many thousands of dollars more a year, so I’d say he did better than Obama.

        Obama lied to get this through.

        1. Karen, I like your feisty spirit

          You and others might enjoy this excellent 2 hour documentary by Ken Burns on the history of the Mayo Clinic (miracle in the cornfield). I found the treatment of the Catholic Faith very well done! Ken Burn weaves a wonderful historical narrative of the holy Catholic Nuns, the Sisters of Saint Francis, who started the original Mayo Clinic, together with the self-less altruism of William Worrall Mayo and his sons

          The Mayo Clinic: Faith – Hope – Science

          1. Estovir, thanks for the link. I enjoy reading about people who lived in service to others.

            I have satellite internet, so I’m limited on how much bandwidth I can use. I’ll save the link and watch it when I visit family.

          1. >>“Repealing it with no replacement at all would be an improvement.”

            >”That is absurd.”

            Why?

            1. Because the rate of premium increases and costs in 2001 would have continued. In other words what’s in the link I posted.

              I’m open to an opinion that Republicans can come up with a better plan. But they’ve had decades to do it.

              If you want to claim that things would be better if they continued along the trend line of the previous decade, I’ll have to disagree with that.

              1. “Because the rate of premium increases and costs in 2001 would have continued. In other words what’s in the link I posted.”

                This is a talking point not an argument with fact. Many people use numbers that are bogus so I guess you have been looking at bogus numbers.

                You forget that health care costs are cyclical and are based on many variables. You also forget how health care costs are calculated. What about all the other comments I made? I guess you lack answers because the cheat sheets didn’t have them.

          2. SteveJ:

            Let me get this straight. Do you believe that they can take away the copays for services, but it won’t affect rates? Do you believe you can require more services, but it won’t affect rates? Do you believe in a magic money tree that springs eternal and pays for everything you want?

            That’s why so few doctors accept Obamacare. In order to try to reduce the astronomical increase in cost, insurers cut remuneration. The law also required reams of added paperwork. Therefore, doctors don’t accept the pay cut and added paperwork.

            I never did find a doctor who accepted it. I had to pay out of pocket to see a doctor.

            There was a lot of talk about “forcing” doctors to accept Obamacare. That would be the next step, government forcing doctors to accept a 30% paycut and added paperwork, which often requires hiring more administrative staff.

            How would you like that, if the government forced you to take a 30% pay cut, and then use the remaining money to hire an employee?

            https://www.nytimes.com/2016/05/15/sunday-review/sorry-we-dont-take-obamacare.html

      3. SteveJ said,
        “Well that isn’t the choice I was given. I was given a choice between doing something and a party that did nothing.”

        That’s his justification for taking away access to cancer treatment, and increasing deductibles from $500 to $12,600.

        I wonder if he’s typing it with a straight face. I wonder if his conscience bothers him, or if he just keeps repeating the sales pitch.

        Deny it all you want. Your vote, along with others who voted like you, made health insurance unaffordable and cancer treatment unaccessible for millions of people.

        There’s no way to justify that. It’s immoral. You either are going to face what you did, and vote differently, or live in denial, vote the same, and hurt millions more.

        The harm occurs, whether or not you admit it.

        1. Your suspicion of how I voted is not well founded. The sentence of mine that you quoted is hardly an endorsement of the Democratic Party. The increases occurring during the last decade would have continued into this decade. I have no idea why you think your premium now would be better if the trend line for the Bush years had continued.

          1. SteveJ – I’ll give you that. Only you know how you’ve voted.

            I vehemently disagree with you on Obamacare.

      4. Bush did nothing about health care? Who told you that?

        https://georgewbush-whitehouse.archives.gov/stateoftheunion/2006/healthcare/index.html

        “Since taking office, President Bush has proposed and implemented commonsense reforms designed to reduce health care costs, expand health care coverage, and improve the quality of care. Many of his initiatives are predicated on the idea of returning greater control and choice to patients, their families, and their doctors. Health Savings Accounts (HSAs), established by the Medicare bill signed into law by the President in December 2003, permit individuals to combine the security of a comprehensive health insurance policy that covers preventive care and larger medical bills with a tax-free account for all other health care expenses. HSAs provide Americans with more control over how their health care dollars are spent and empower consumers to take more control over their health. HSAs are making health insurance more affordable and are helping companies lower their health costs. More than three million Americans now have HSAs.

        The President has also implemented much-needed reforms to help speed the introduction of generic pharmaceuticals into the market. Generic drugs provide a more cost-effective way to deliver much-needed medicine to patients, but in the past, generics often faced obstacles to getting to the market. The President’s actions mean that generics are now much more likely to reach the marketplace without delay, saving American consumers billions of dollars each year.

        Through his Community Health Centers initiatives, the President has made access to primary and preventive health care services for vulnerable populations a priority. The Administration has funded more than 800 new or expanded centers, and will fund approximately 400 more over the next two years. New funding has allowed Community Health Centers to build the capacity to serve more than 3.5 million additional Americans, with nearly 2 million more to be served in the next two years.

        In 2004, the President launched an initiative to make electronic health records available to most Americans within the next 10 years. This technology will help to link together doctors, patients, and hospitals in seamless, digital environments, making it possible for a patient’s records to be transferred quickly and accurately and with all necessary privacy protections. The technology has already developed to the point that many hospitals and medical systems can track patient records, lab tests, drug administration, and follow-up care, but more must be done to improve consumer access to this technology. Widespread use of electronic health information will help Americans receive high-quality medical care, save lives, and prevent medical errors. The use of health IT by the Department of Veterans Affairs and the private sector has already led to significant cost savings, reduced errors, and improvements in quality of care.

        Back to Top

        THE PRESIDENT’S VISION

        In an ideal system, Americans would be able to choose their health care based on their individual needs and preferences. Information about the range, price, and quality of available health care options would be readily available and easy to use. Purchasing decisions would be made by consumers, not by employers, insurers, or the government. Health insurance would be portable (meaning you can take it with you when you move or change jobs) and affordable. Competition and market forces, rather than government price controls, would be relied upon to improve the quality and efficiency of health care and to reduce the growth of health care costs.

        The President’s reform agenda can make the health care system more efficient, while ensuring that it continues to lead the world in cutting-edge medicine. The President proposes to limit the unsustainable increases in our health care spending through initiatives that will inject consumer involvement back into the health care system.

        The President believes that empowering consumers is essential to improving value and affordability in American health care. Americans should be able to choose their health care based on individual needs and preferences. Americans should be able to easily obtain understandable information about the price and quality of health care. Medical providers and insurance companies have a responsibility to provide this information to all Americans prior to the time of service or treatment.

        The introduction of HSAs is leading to a major shift in health care in America. More employees are able to afford high-deductible health insurance combined with HSAs, allowing them to gain control over their health care dollars. In addition, HSA-based insurance allows more workers to have insurance for major medical events, which will reduce the financial burden currently carried by various government and non-profit entities. Expanding HSAs will strengthen the doctor-patient relationship and lead to better value in health care.

        Insurance should be affordable and provide increased stability and peace of mind for working families across the country. The President has proposed the creation of Association Health Plans (AHPs), which will allow employers, especially small businesses, to band together and purchase health insurance across state boundaries. By purchasing coverage for thousands of employees at a time across many different small businesses, association members can pay lower premiums for better coverage, as some large companies can today.

        Americans should not have to worry about changing doctors, learning a new insurance bureaucracy, having their premiums go up if a family member is sick, losing their insurance tax advantage when leaving employment-based plans, or being subject to more costly mandates. The President believes Americans should be able to purchase health insurance across state lines and take it with them wherever they go.

        President Bush continues to call for medical liability reforms that would help protect both doctors and patients. These reforms would reduce the likelihood that doctors and hospitals order more tests or procedures than are clinically necessary to help protect against liability claims. Such defensive medicine drives up health care costs but has little or no medical benefit. Medical liability reforms would protect a patient’s access to the courts but place reasonable limits on the extent of potential awards.

        Our government has a responsibility to promote access to quality affordable health care for the poor and chronically ill. The President’s proposals would provide important assistance to these vulnerable Americans, extending extra financial assistance to low-income Americans; encouraging states and employers to help the chronically ill obtain affordable health coverage; and allowing individuals to purchase affordable insurance through their civic, community, and religious groups. Promoting these initiatives, and continuing to increase support for Community Health Centers, will ensure health care is available where it is needed most.

        Finally, President Bush believes that active prevention is critical to achieving a better and longer life, and should play a central role in any effort to control the costs of health care. He has therefore made the adoption of a healthy lifestyle a high priority and has encouraged Americans to take responsibility for making wise choices that point toward fitness and health. His Administration has worked to give all Americans the tools, skills, and motivation to improve their health and wellness.

        Back to Top

        ACHIEVING THE VISION

        The President’s vision will be achieved through:

        Leveling the playing field by making the same tax relief available to individuals and employers. Americans who purchase HSA-qualified insurance policies on their own should have the same tax advantages as people who obtain insurance through their employer.
        Eliminating all taxes on out-of-pocket spending through HSAs. Americans with HSAs should be able to pay for all of their care tax-free.
        Making health insurance portable. Americans should be able to own the insurance policy that goes along with their HSA, and keep it when they change or lose their jobs without worrying about paying higher premiums if they become sick.
        Strengthening the buying power of America’s small businesses. Small businesses should have the same access to price efficiencies as large businesses when purchasing health insurance.
        Passing medical liability reform. Limit costly and frivolous lawsuits that waste scarce resources, increase health care costs, and drive doctors out of business.
        Improving adoption of health information technology. Electronic health records that reduce costs and improve the efficiency and effectiveness of medical treatment should be widely used.
        Empowering consumers through information. All Americans should be able to obtain easy-to-understand information about the price and quality of the health care they receive from their medical provider and insurance carrier.
        Providing affordable coverage for vulnerable Americans. Americans with low incomes and persistently high medical expenses should receive additional assistance.
        Promoting prevention, wellness, and fitness. The President encourages all Americans to lead a healthy lifestyle to prevent disease and improve their overall quality of life.”

    2. Karen, dont be pretentious. The Trump tax cuts may cost more than Obamacare. And Medicare-For-All would be insanely expensive.

      One should note that before Obamacare, hospitals were getting constantly burned by the uninsured. And Republicans had no solution to deal with that issue.

      1. Phillip:

        “Karen, dont be pretentious. The Trump tax cuts may cost more than Obamacare. And Medicare-For-All would be insanely expensive.”

        Citation, please.

        Tell me exactly where my honest, sincere criticism of Obamacare, complete with explicit explanations is “pretentious.”

        Cite where the Trump tax cuts “may cost more than Obamacare.”

        I’m not paying more than $12,600 deductibles and $1200/month because of a tax cut.

        There are too many Democrats that believe that every dime you earn belongs to the government, as if you are a slave. They magnanimously allow you to keep some. You are lucky you are able to keep anything. A tax cut is viewed as a lost. Your earnings are theirs. They may raise taxes, but if anyone ever reduces them, it’s stealing from your masters.

        That is where Leftism ultimately leads. It makes a government so powerful that in the end, individuals no longer have rights. Not over speech, not over earnings, not over labor. It all goes to the government.

        Republicans had no solution so…take away cancer treatment access from millions of people.

        You guys keep saying the same thing. You had to burn the house down with termites because someone had to do something. No. You do not harm millions of people. That is immoral. I don’t know why this does not penetrate.

        Let me repeat: Lying that you will save money, keep your doctor, and keep your plan, only to jack up insurance until it is unaffordable is immoral. Lying and claiming that Obamacare cannot be repealed because it is too big to fail, and then later proposing that you do just that and replace it with single payor is immoral. Lying and claiming that critics of Obamacare don’t want the poor to have access to health care is immoral.

        1. Karen your comments typically go one of two ways.

          1) The All-Encompassing What About.

          At least 12 What Abouts packed together creating a nuclear What About. One that blows liberals off the blog! Their faces, at the computer screen, melt like grilled cheese. Because they were stupid enough to take on Karen S.

          2) Greatest Hits of Conservative Teachings.

          Vague, general arguments reviewing famous talking points since the Reagan era. Liberals are cast repeatedly as unrealistic twits. Adolescent types who know nothing about economics. Because real adults are always conservative. People get conservative with age. Trumpers especially.

          CAUTION: # 2 plays best to Trumpers. People on the outside see it as corny.

    3. Obamacare is Romneycare

      Why can’t republicans be honest?

      The mandate is the republicans idea

      They called people who didn’t have insurance freeloaders

      1. Obamacare is Romneycare

        1. It isn’t.

        2. No, the mandate is not a ‘Republican idea’.

        3. Romney had to work with a Democratic legislature to attempt to repair a ruined market in Massachusetts. He wasn’t going to get what he wanted. He was going to have to accommodate them.

        4. Stop lying.

        1. From its inception, the idea of an individual mandate was championed by Republican politicians as a free-market approach to health care reform.

          1. Steve, do you not understand that each mandate championed was different than the Obamacare mandate. Some Republicans pushed them and many did not. Most conservatives that pushed mandates agree they were wrong and understand why. However, these Republicans were talking and did not research all the points to put them in a bill. Had they done so it is likely they would have changed the mandate even more so that no one was forced to buy private health insurance. In fact that was the attempt of some of those mandates. Obamacare’s intent was to force people to buy private health insurance.

            Do you recognize the difference between the Obamacare mandate and any of the other mandates you mentioned? I don’t think so even though I posted some of the differences earlier. It seems you keep spouting the word mandates as if all mandates were equal.

            No Republican to my knowledge EVER supported a mandate like the one in Obamacare. You can end your dellusions that the Obamacare mandate was a Republican invention.

  7. Democrats just cannot seem to accept the reality of Obamacare.

    You can direct them to the Exchange. You can quote the Exchange. You can link to 100 articles investigating and confirming what I personally experienced.

    They’ll just say, that can’t be right, and continue to vote as usual…which is irresponsible and immoral. It hurts people. The harm is done whether or not you admit your own guilt in the matter.

    Making middle class families pay $1200 a month in premiums and $12,600 in deductibles for a plan that many doctors won’t accept should be a crime. It’s certainly not ethical.

    Pin them down and ask if that’s right, and they’ll either say you must not want the poor to have health insurance, or it just can’t be right.

    That’s the malleable nature of morality.

    These very people would be outraged if Trump made them pay $12,600 or removed their access from their own doctor. But if it happens to some abstract “other people” they can’t see, then they can dismiss it. Can’t be true. My politicians wouldn’t lie to me, would they? I just won’t read the articles disproving the lies. I won’t acknowledge the inhumanity of taking away someone’s insurance that covered cancer treatment centers, and replaced it with something unaffordable that does not get accepted at those centers.

    I just won’t think about it, but I’ll tell myself that I care more about the poor than others.

    1. If you vote for those who would continue Obamacare, or do one worse and go to single payer, do you still consider yourself a moral being? You’ve got to know by now the harm it’s done. The lies that were told to pass it.

      Do you lie to yourself and claim you’re a moral being? But you know. Way down deep, there’s that disquiet. The nagging feeling that more and more people are acknowledging that health care is unaffordable. The articles showing up on so many newspapers now. The Clintons acknowledging it. AOC acknowledging it. You don’t understand. They said it would save middle class families $2500 a year. That can’t be right. But…it is right. Why didn’t Obamacare work? They said they can’t repeal it because it’s too big to fail. Yet…that’s not the truth either because now they’re pushing for single payer. If Obamacare is too big to repeal then we couldn’t have single payer, either.

      Hmmm, it’s almost like politicians have been lying…Deliberately…taking advantage of the “stupidity of the American people.” Do you want to be the group that those politicians consider stupid? Or do you want to stop them?

  8. Not to worry, Trump said he has something better, like his wall and middle class tax breaks.

  9. Someone send a copy of the Constitution over to the Supreme Court. It may find the document useful and pertinent. Oh, and all Americans can read the English language and have absolutely no need for “interpretation” or, otherwise, pompous and arrogant elitism by the judicial branch, which has no power to legislate or modify legislation and is charged solely with assuring that actions comport with statute and fundamental law. Government exists only to facilitate the maximal freedom of individuals through the provision of security and infrastructure under the dominion of the Constitution and Bill of Rights, not under the dominion of decisions, adjudication, precedents or “case law” decreed by the haughty judicial branch, aka “legislation from the bench.” The Supreme Court and judicial branch labor or work for the American people; they don’t govern and rule over them. The American Founders transformed the People into the “Sovereign” and government into the “Subject” of that “Sovereign.”

    Article 1, Section 8, provides Congress the power to tax ONLY for “…general Welfare…,” deliberately omitting and, thereby, excluding, any power to tax for individual or specific welfare, aka redistribution of wealth, consisting of roads, water, sewer, post office, utilities, trash pick-up, etc. (i.e. commodities and/or services that all people use in and at similar amounts and frequencies).

    Further, the same article provides Congress the power to regulate ONLY the “value” of “money” and “…Commerce with foreign Nations, and among the several States, and with the Indian Tribes;…” for the sole purpose of precluding bias or favor by one nation, state or tribe over another. Congress has no power to regulate anything other than the value of money and the flow of commerce between jurisdictions.

    Conclusion:

    Between the absolute constitutional right to private property and Article 1, Section 8, Obamacare and the entire American welfare state are irrefutably anti-American and unconstitutional.
    _______________________________________

    Article 1, Section 8

    The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

    To borrow money on the credit of the United States;

    To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

    To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;

    To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;

  10. well part of the problem is we have people living longer and longer often means sicker. there’s no easy way to address that. diet and healthy habits are important but to some degree will just push the problems out longer and then other ones show up. such as dementia for all the healthy bodied old folks out there who are losing their memory even though all the other systems are still working ok. we will see more of that in due time even if general health habits improve. there is no solution for death, in short. its worth keeping that in mind.

    economically, health care is often not like other goods or services, in ways that should be meaningful when considering market based pricing solutions.. a couple examples:

    some of it can be very price inelastic like insulin, very expensive, will be demanded at any price, because few or no substitutes, and the loss of the good means death

    second issue is its collective karmic effect. what i mean by that is, worse public health affects everyone, potentially. most of all with contagious illnesses. those need to be treated or everyone can get sicker and sicker. so public health is a very real thing on the gross, and needs consideration from a bird’s eye view and not just from a person by person perspective.

    so there is a qualitative difference in the demand for certain aspects of health care, from other goods and services, because of social connectedness. But, it would be foolish to run from this basic insight, straight into the arms of socialists. I’m not sure Obamacare was as bad as that, though certainly they said so.

    Certainly, market solutions are important. Let’s take an example. And market solutions will always exist even when theory says otherwise. For example. People may not know that in Communist China, in theory they have “Free” universal coverage. In theory. Anglosphere internet sites sometimes quote this lie as if it was true:
    https://www.internations.org/go/moving-to-china/healthcare

    Well they said there are “gaps” in coverage. Ha, Understatment. Lol. Oh, there are “Gaps” alright. like, you have to pay a cash bribe if you need any surgery whatsoever!

    which means in practice, there is government subsidy, but every user gets tapped for fees, even if they’re black market. And the black market pricing systems are present in a majority of transactions for major medical services. Now that’s Communist china for you. They solved the rationing problems of the command pricing system by making a free market tacitly legal whatever the written laws may be.

    In China, plus ca change, plus le meme chose. Whatever the laws on paper, or the name of the system, for centuries the local people have done business according to their peculiar customs and not even the brutally murderous Communist regime could change the habits of the Middle Kingdom people in the end. And, take careful note of this, they invented paper money in the first place. So they know more than a little bit about markets and business going back for centuries.

    for the well heeled and foreigners, they also accept private health insurance.

    1. There may need to be some re-evaluation of what has become accepted societal ethics.

      I think my experience with my Dad is somewhat common and continues to become more so. Developed heart disease 4-5 years before he passed on. While both of us appreciated the role of the cardiologist in making him comfortable, more and more doctors insisted on seeing him with increasing frequency for more “necessary” things until he was seeing a doctor for something or other once a week. I think that got him down and affected his quality of life. I think it has become implied that you are not being responsible if you do not comply with these kinds of doctors orders. So he waited longer than he would have in deciding to ignore them. He wanted to enjoy his week.

      Seeing doctors once a week ad nauseum for questionable reasons under his circumstances seems like a relatively new development — and not one that strikes me as all that helpful. I’m skeptical he lived any longer as a result. I think since he had an ordinary Medicare insurance plan and it has become commonplace for such plans to cover this kind of thing, as I said above I think there was an implication that he ought to be “responsible”.

      If there are some people who enjoy it, I suppose they are entitled to do so, but I don’t know if it ought to be part of an ordinary insurance plan. They can start paying out of pocket or purchase more expensive plans.

  11. This article is like a Christmas present for me, special.

    I love the opportunity to expound on the many reasons why Obamacare should be repealed.

    Thank you, Professor Turley!

    Ceterum censeo Obamacare delendo est.

    1. Karen, are you on Medicare? Or are you fortunate enough to have generous private coverage?

      I just dont get why someone would consider this a “Christmas gift”. Like you dont want the less fortunate to have health insurance? Like it warms your heart that someone might die of cancer because they lack healthcare?

      It’s a strange commentary on Trumpers that they would welcome this news when their own party has no health plan after 10 years of sabotaging Obamacare.

      1. The American thesis is Freedom and Self-Reliance. It is not fortune that provides, it’s endeavor and free enterprise. It’s not the government that provides, it’s every person’s own hard work.

        Charity, under the Constitution, is industry conducted voluntarily in the free markets of the private sector. Americans are free go give all their assets to anyone they choose and they are free to start a business in the charity or any other industry.

        Government cannot tax for indivdual welfare, aka redistribution of wealth.

        Please, be free and go “pursue happiness.”

      2. I am passionate about ending the humanitarian crisis that is Obamacare. I suffered under it until a relative was able to get me a telecommuting job that had health benefits. Even though I no longer have to deal with the false promise of healthcare that Obama represents, I cannot forget the millions languishing with this over priced, substandard car.

        If you don’t care that middle class families have to pay $12,600 in deductibles, or you don’t care that the poor still don’t have access to high quality care, then that’s on you.

      3. Here Phillip Skene illustrates for us the common Leftist tactic. Do not address a single fact or point presented in an argument. Instead, go ad hominem with a false accusation. “Like you dont want the less fortunate to have health insurance?”

        Hey, Phillip:

        1. Don’t you care that middle class families have to pay $12,600 in deductibles and $1200 monthly premiums?
        2. Don’t you care that Obamacare is not accepted by many doctors or cancer treatment centers because of the pay cut?
        3. Don’t you care that the poor don’t have access to the same quality healthcare as an employer policy?
        4. Don’t you care that if you have cancer, Obamacare may take your chance at remission away?
        5. Don’t you care that Obamacare took away off formulary drug benefits? If your medication isn’t covered, now there is no coinsurance, and it won’t count towards your max caps.
        6. Don’t you care about the restricted provider networks? People on Obamacare can’t find good doctors.

        Well, Phillip. Don’t you care? Why are you so heartless and callous as to support Obamacare taking treatment away from cancer patients.

        Harsh.

      4. I just don’t get why someone would consider this a “Christmas gift”.

        Hill,
        You often state you don’t get or you don’t understand. It’s at that point myself and others present to you information that explains why we believe in a way you declared you don’t get, with the expectation you will read and begin to understand what you previously didn’t get. Please note that this does not require you to accept it. The only purpose would be to take you from not understanding, to understanding. If you still don’t get it, then it would be customary to ask additional questions until clarity is made.

        The Law by Frederic Bastiat is a great source to get answers to your question above. The entire pamphlet is rather short. Here is a portion of that pamphlet that would address your question. If you have questions, I would be more than happy to address them.

        The war against illegal plunder has been fought since the beginning of the world. Long before the Revolution of February 1848 — long before the appearance even of socialism itself — France had provided police, judges, gendarmes, prisons, dungeons, and scaffolds for the purpose of fighting illegal plunder. The law itself conducts this war, and it is my wish and opinion that the law should always maintain this attitude toward plunder.

        The Law Defends Plunder
        But it does not always do this. Sometimes the law defends plunder and participates in it. Thus the beneficiaries are spared the shame, danger, and scruple which their acts would otherwise involve. Sometimes the law places the whole apparatus of judges, police, prisons, and gendarmes at the service of the plunderers, and treats the victim — when he defends himself — as a criminal. In short, there is a legal plunder, and it is of this, no doubt, that Mr. de Montalembert speaks.

        This legal plunder may be only an isolated stain among the legislative measures of the people. If so, it is best to wipe it out with a minimum of speeches and denunciations — and in spite of the uproar of the vested interests.

        How to Identify Legal Plunder
        But how is this legal plunder to be identified? Quite simply. See if the law takes from some persons what belongs to them, and gives it to other persons to whom it does not belong. See if the law benefits one citizen at the expense of another by doing what the citizen himself cannot do without committing a crime.

        Then abolish this law without delay, for it is not only an evil itself, but also it is a fertile source for further evils because it invites reprisals. If such a law — which may be an isolated case — is not abolished immediately, it will spread, multiply, and develop into a system.

        The person who profits from this law will complain bitterly, defending his acquired rights. He will claim that the state is obligated to protect and encourage his particular industry; that this procedure enriches the state because the protected industry is thus able to spend more and to pay higher wages to the poor workingmen.

        Do not listen to this sophistry by vested interests. The acceptance of these arguments will build legal plunder into a whole system. In fact, this has already occurred. The present-day delusion is an attempt to enrich everyone at the expense of everyone else; to make plunder universal under the pretense of organizing it.

        Legal Plunder Has Many Names
        Now, legal plunder can be committed in an infinite number of ways. Thus we have an infinite number of plans for organizing it: tariffs, protection, benefits, subsidies, encouragements, progressive taxation, public schools, guaranteed jobs, guaranteed profits, minimum wages, a right to relief, a right to the tools of labor, free credit, and so on, and so on. All these plans as a whole — with their common aim of legal plunder — constitute socialism.

        Now, since under this definition socialism is a body of doctrine, what attack can be made against it other than a war of doctrine? If you find this socialistic doctrine to be false, absurd, and evil, then refute it. And the more false, the more absurd, and the more evil it is, the easier it will be to refute. Above all, if you wish to be strong, begin by rooting out every particle of socialism that may have crept into your legislation. This will be no light task.
        http://bastiat.org/en/the_law.html

      5. The garbage being spewed by Peter Shill above is coming from an individual that has agreed with killing babies soon to be born and those that have been born, prefers his ideology to minorities having good jobs, is willing to make healthcare insurance unaffordable to working families and thinks cancer is treated by Obamacare in the same fashion as prior healthcare was able to do. He also likes to transfer government help from the very needy to those not so needy.

        He lacks the wit to defend his positions and he lacks the knowledge to be able to provide the facts and back up his positions. He relies on hit pieces that tell only a small part of the story while leaving out everything Peter doesn’t like.

    2. You have been paying subsidies on emergency room costs for others, as well as delinquent hospital bills for other, and therefore your overall hospital costs for years.

      The rate of increase for health care costs has gone down since ACA as well as your premiums.

      As I said below, if your premiums are rising faster now than under George W. Bush, I suggest you do some research on your insurance company,

      1. Hey SteveJ:

        I taught you a neat math trick in my reply to your post down below. It explains the difference between dollar amount and percentage. It’s how politicians take advantage of the those without any savvy.

        1. Ha! Well the rate of increase doesn’t just stop. You have to do something to the system to make it stop or slow it down. The rate of increase that was occurring under Bush would have continued (in fact the rate itself would have increased) without the ACA. .

          1. SteveJ – Obamacare caused premiums to rise exponentially. My deductible went from $500 to $12,600. I’m no longer on Obamacare, thank God.

            This is immoral.

            Just stop. How could you defend this? It took away access to cancer treatment. Find your conscience.

          2. Steve, you have to be careful drawing conclusions. Health care costs are cyclical so you can’t be so sure of yourself. You also have to define what you are talking about. These generalizations you make on a continuous basis appear force fed without any foundational knowledge.

  12. —————Will Voters Please Stop Screwing Over Their Neighbors?—————————–

    Politicians should have targeted help to the poor who could not afford insurance. They should have improved their access to quality health care.

    Instead, they took away access to health care from the unsubsidized middle class.

    Did you know that the family deductible for an Obamacare policy in CA is now $12,600? This is for a middle class family. Not a single doctor I ever went to accepted Obamacare. I used to take pictures of the “we don’t accept Obamacare” signs in the lobby for my friends who doubted me.

    Did you know most major cancer treatment hospitals don’t accept Obamacare?

    Did you know that Obamacare caused drug formularies to tighten, and the loss of off formulary benefits? Insurance used to pay some of the cost of drugs that were not on their formulary. Now, it’s all out of pocket, and won’t count towards your max caps.

    Did you know that insurance companies are leaving Exchanges in droves because Obamacare made them lose too much money, even when charging astronomical rates? There are now Exchanges with zero or one insurer.

    Did you know that the poor still don’t have access to the same quality of care as someone on an employer policy? Now, they have more company – the unsubsidized middle class stuck with Obamacare.

    Don’t you want access to the best doctors if you get cancer?

    Don’t you care that because of Obamacare, the unsubsidized middle class cannot afford their insurance?

    Don’t you want consumers to have a choice in plans? Obamacare is all the same plan, just as slightly different premium/deductible distribution.

    It is unethical to hurt one group of people to try to help another. It is unethical to promise one group of people access to the same quality of care as an employer policy, but instead deliver county level care.

    coveredca.gov

    An unsubsidized policy for a family of 3 on the Covered CA website generates 2020 pricing of a monthly premium ranging from $944 to $1262, with deductibles of $12,600. This is for a policy that literally no doctor I ever went to would accept! Most cancer treatment centers won’t accept it. Out of state treatment centers won’t accept it. This is the most expensive, useless piece of excrement that any politician has ever inflicted upon a populace not savvy enough to stop them.

    When Obamacare first hit, the percentage increase was astronomical. Now, the percentage increase is lower year to year than in the first few, but that percentage is taken from a much higher number than 10 years ago.

    For instance:

    Increasing a deductible from $100 to $500 is a 400% increase.

    Increasing a deductible from $500 to $6000 is a 1100% increase. The difference is $5500.

    Increasing a deductible from $6000 to $12000 is a 100% increase. The difference is $6000

    Increasing a deductible from $12,000 to $12,600 is only a 5% increase. It’s still $600.

    One should note that politicians will always talk about the percent increases. They will declare that the percent increase is slowing down, and it is, percentage wise. But 100% of $6000 is still more money in total than 1100% of $500.

    The middle class cannot afford us. Politicians royally screwed us over, and then lied to employer policy holders, who were mostly shielded from the Extinction Level Event of individual access to health care. They lied and told them Obamacare was just wonderful.

    Now, they admit that healthcare is more unaffordable than ever. But it’s not the Democrats’ fault! They swear! It’s not like their voters will ask if it’s their fault. No, it’s the fault of the evil insurance companies. They must demolish them and meddle even more!

    1. Oh, and that cheapest plan that came in under $1000 monthly premium? That’s LA Care Health Plan – created for Medicaid.

      County level care.

      1. He is self employed with a grandfathered policy. Agents have told us that it is impossible to get a policy that good ever again. Get that? Insurance agents say that preexisting policies blow Obamacare out of the water.

        Insurance companies are trying to get them to fall off. They are also increasing the price to make those plans go away. If you make a change to your policy, you will lose your grandfather status. That’s how I lost mine. We had a baby. My husband has required a few surgeries due to the nature of his work. He cannot lose that policy, as it gives him access to the top doctors. Just like my old one used to. If the insurer makes any change to that policy, such as change the annual limit or cost sharing percentage, it loses grandfather status. Various agents advised us not to try adding me.

        I am not on Obamacare anymore. My relative was able to get me a part time telecommuting job with his company that gave me access to an employer policy. It’s like what I used to have before Obamacare destroyed my health insurance.

        1. Karen based on what you have been saying it seems that in part your premium went up under Obamacare because your premium was used to subsidize the lower income group.

    3. Karen, we dont see any sources for your numbers here. We have no idea where you’re getting them.

      Your numbers for a family of 4 are questionable. Children are usually pretty cheap to insure. It’s mainly adults over 50 who really cost.

      2. Phillip:

        “Your numbers for a family of 4 are questionable.”

        That’s right. My numbers were for a family of 3 on the coveredca.gov website. That’s the unsubsidized price.

  13. Obamacare is the most expensive individual insurance plan in US history.

    Most doctors don’t accept it. After paying the equivalent of a second mortgage for the insurance, you’ll still have to pay out of pocket to see a doctor. Obamacare created an avalanche of paperwork for physicians, and a 30% pay cut here in CA.

    Most top cancer treatment centers don’t accept it. If you have Obamacare, it might have cost you your chance at remission. The major insurance policies on the free market before were accepted.

    Die Obamacare, die!!!

    I will never forgive Republicans in Congress for not having the spine to defeat this humanitarian catastrophe.

    Democrats called people like me a liar for years, claiming I was misrepresenting Obamacare. Now they admit it’s all true, but won’t admit their guilt. Now, they’re trying to sell the story that evil insurance companies suddenly became unaffordable for absolutely no reason at all. Now they are pushing for single payor, which will cost us even more. Only, since it will be called a “tax” instead of a “premium” or a “deductible”, they are counting on the “stupidity of the American public” not to do the math.

    Democrat politicians created a financial hardship for millions of people. They took away their access to healthcare, when they created plans that doctors could not afford to accept, without turning to a high throughput factor model. They took away access to cancer treatment for millions of people.

    But since this did not affect the majority of Americans, who had employer policies, too many voters could care less.

    Single payor would hit everyone. Since everyone would pay those taxes regardless of whether they used the service or not, there will be increased demand for services. There’d be no point for waiting to see if a common cold resolved on its own. So, like the rest of the world, they ration access to care. We’d be stuck with unaffordable taxes, and months long wait times.

    The open border Democrats running the party would offer this to illegal aliens. Deep Blue CA already has moved to offer free healthcare to illegal aliens. If we thought there was an intense draw for millions of people to flood our borders and exhaust our support services already, just wait. Since Democrats even oppose deportation of those who have gone through the court process, there is no reason they will apparently support to deny anyone access to the US. We do not have the room, housing, water, or benefits structure to care for billions of people. Billions of people don’t share Western values. Open borders plus even more benefits for all who would come would mean the end of the United States.

    Vote responsibly in 2020.

  14. The issue of severability will eventually go to the Supreme Court, so why does the country have to wait for a new decision on remand from the District Court? The record below probably supports ongoing injury and standing by the plaintiff-states; the appellate dissent certainly doesn’t lay a glove on that. So there’s enough for SCOTUS to rule on what Congress intended. And unless it affirms the district court outright (doubtful), we’ll be cleaning up this mess for years, no matter how much of the ACA survives. Best to save at least a couple of those years now.

  15. Now if they could just get rid of those useless to me medicare payments sucking up a chunk of my retirement money.. the retirement which promised medical for life. Just hope the people with the dread Pelositis disease don’t get out of the hospital in time to cast their illegal ballots.

  16. Until Americans pay for their unhealthy “lifestyle choices”, all of us healthy types will be paying for their choices. By the year 2030, 50% of Americans will be obese, and 25% will be severely obese.

    Bring back fat shaming. Charge higher plan premiums and health care costs to those Americans who are obese or worse, severely obese. For those Americans who practice preventative medicine on a daily basis (healthy diet and exercise), their health care costs and plan premiums should be far lesser than what obese Americans pay. An obese BMI > 31, white American, age 50, who takes prescription medications for Type II Diabetes, hypertension, heart disease/cholesterol meds, has sleep apnea, consumes far more prescription drugs and physician visits than a White American, age 50, BMI less than 26, has a healthy nutritional diet (e.g. Mediterranean diet) and exercises regularly, and does not require any prescription meds with yearly health physicals. Start there

    Create health care plans and create clinic fees for those Americans who comport to healthy indices.The above referenced obese man should be charged far more in premiums and costs. The above mentioned man with a BMI of < 26 should be charged minimal costs for health care and a pay a fraction of what obese members pay for plan premiums

    Addiction is addiction. Smokers pay more for health care plans. So should obese. Americans railed against smokers as a stigma and shamed them. Do so for obesity as well.

    Other than that, eliminate all present obstacles to the physician-patient relationship, which barely exists today due to health care plans and business metrics. Let the patient enter into a private contractual relationship with the physician, just like individuals do with plumbers and lawyers (no offense to plumbers), and fire all of the voyeurs. Throw a Krispy Kreme donut to the latter and they'll be happy

      1. What is your source, Paul, for your statement?

        You may not like the BMI method, and I have already mentioned previously my BMI and hence the limitations with that metric (kg/m^2), but for now it is the gold standard to categorize body habitus.

        Medicine is continually self-correcting itself, because it must. You are old enough to recall the “rationale” that was offered decades ago about peptic ulcers, i.e. stress, anxiety, red sauce, spicy foods. That was bunk but back then it was the dominant paradigm. Today we know most duodenal ulcers are caused by a bacterium known as Helicobacter pylori. What was true years ago in medicine is possibly bunk today. However today’s medical paradigms, like them or not, have their place because we lack better analysis.

        Yesterday I posted an NEJM article related to obesity trends in our nation and predictably they used BMI as their metric. BMI was mentioned 83 times in the article.

        Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity | NEJM
        https://www.nejm.org/doi/full/10.1056/NEJMsa1909301

        If you have a better method than the BMI, please state with sources (OEM not necessary)
        😉

        Obesity kills and if people want to wallow in it, then go for it. However it drives up the costs of both medical care and health insurance premiums much like smoking. I already made my argument on that note so feel free to rebut with sources. The costs of medical care are inexcusable hence my comments on how to address them, TIA’s kvetching, not withstanding. People who are healthy should not be part of the same actuary pool as those who are unhealthy like smokers and obese Americans. Obamacare is not the answer.

        Here is another article for you from the distinguished Journal of American College of Cardiology. The link provides free access of this very well known and often cited article. Read the whole article, though…don’t get bogged down on the minutiae that is over your head. Just read through it once and get the main points of the article.

        Epicardial Adipose Tissue May Mediate Deleterious Effects of Obesity and Inflammation on the Myocardium
        https://www.sciencedirect.com/science/article/pii/S0735109718343730

        Obesity promotes systemic inflammation 15, 16, and its presence adds to the inflammatory burden of many chronic noncardiovascular inflammatory disorders; this augmentation explains why obesity adversely affects the clinical course of rheumatoid arthritis, human immunodeficiency virus infection, and psoriasis 17, 18, 19. It is well established that the systemic inflammatory response in each of these disorders can adversely influence the coronary arteries. Obesity, rheumatoid arthritis, human immunodeficiency virus infection, and psoriasis are all accompanied by accelerated coronary atherosclerosis and an increased risk of myocardial infarction 20, 21, 22.

        …

        Why does obesity cause this biological transformation of epicardial adipose tissue? There is a close relationship between body mass index and the quantity of visceral fat, such that the thickness of epicardial adipose tissues increases as people gain weight (83). The inflammation caused by adiposity may also promote the accumulation of epicardial fat, which also accumulates in other chronic inflammatory disorders 24, 25, 26, 27, 28. Additionally, increases in body mass are paralleled by an increased production of aldosterone, which is synthesized excessively both by the adrenal gland and by adipocytes in obese people

        1. Estovir – if I am a teen girl with a D-cup weighing 130 and I am 5’2″ I am fat according to the BMI. However, I have hair down to my waist, which is not taken into consideration, nor that I walk 2 miles to school, so I have zero body fat. You have no idea how many young women have come in to me as a teacher complaining their doctor said they were fat.

          1. Paul, you should publish your findings in an established periodical with a sizable readership. Im sorry I have no connections at Mad Magazine or Babylon Bee, but given your rigorous DDData, you will have your hands full with that cross your heart Playtex bra, Bruh!

            Don’t ever go after David Benson again about OED citations
            😉

  17. As someone who worked 3 jobs and pulverized my hips to the point I needed surgery but couldn’t afford insurance previous to the ACA and the individual mandate, I’m biased. The issue may be muddled…, but so is the healthcare system. Essentially, in dollars and cents, what the individual mandate meant to me was being able to have hip surgery (and therefore be able to put my shoes on in the morning without dislocating my hip every single time) for 7 grand versus upwards of 30 grand. I could swing 7 grand, not 30. Previous to that insurance would’ve cost near a grand a month with an 18 month to 2 year wait for surgery. I was caught in the ‘make just enough money to get bounced out’ group. Landscaper and basketball coach. I see this as the legal lingo for what I heard along the way: gee that’s awful you got so caught up in this unfortunate situation but don’t make me pay for your surgery. This, of course, is incredibly overly simplistic and misses the forest for the trees.

    1. Paul, I am glad you got surgery. Even a bad law can do good for some people but harm to others and to the country. We need good laws. Obamacare is not a good law.

      1. We need good laws. Obamacare is not a good law.

        We need responsible Americans. No law, no regulation, no federal mandate can undo the damage that Americans choose to do by engaging in unhealthy lifestyle choices.

        preventative medicine is the single most important factor that can drive down costs. Most chronic medical problems are due to lifestyle choices.

        1. The mandate requires Americans to take some responsibilities for themselves. In that way it saves me money in terms of other peoples hospital bills and emergency room expenses.

          The reason medical bills have risen is because neither political party will address the issue of health care costs which have little to do with your analysis and everything to do with increasing the demand curve resulting in the price going up as well as an increase in unnecessary procedures.

          1. “The reason medical bills have risen is because neither political party will address the issue of health care costs”

            Steve, how do you propose the political parties address the issue of healthcare costs. Be specific and skip the generalities.

            1. I don’t see that you can do much about it without addressing Medicare. And Ws Medicare Modernization Act i.e. Medicare Part D didn’t help matters any.

              Be glad the ACA passed and don’t meddle with it unless you know what your doing.

              The only time medicare was addressed to my knowledge was when Obama reduced payments to Medicare Advantage Providers who were overcharging.

              1. Steve, you are leaving us with generalities that are meaningless to the discussion. You have no ideas and have strayed a bit from the core.

                Yes one can work without addressing Medicare and yes one should address Medicare. Part D as you say made things worse and at the time. I stenuously objected to Part D before its passage but we have to live with it for now. Trump is pushing to lower drug prices and I believe he is succeeding and will succeed more if given a bit of space.

                The ACA was unsustainable when passed so your comment “Be glad the ACA passed and don’t meddle with it” demonstrates your need to read more.

          2. “The mandate requires Americans to take some responsibilities for themselves. In that way it saves me money in terms of other peoples hospital bills and emergency room expenses.”

            Obamacare costs the unsubsidized family of 3 over $1000 in monthly premiums and $12,600 in annual deductibles.

            It is not accepted by most doctors.

            It is not accepted by most cancer treatment hospitals.

            It has done away with off formulary drug benefits, and tightened the list of approved medications. If your medicine is not covered, you pay out of pocket and it won’t count towards your max caps.

            This is immoral!

            “The reason medical bills have risen is because neither political party will address the issue of health care costs”. NO. Medical costs rose as a direct result of Obamacare.

            Copays were developed in order to bring overall costs down for consumers. If you were on birth control, you’d pay a $5 copay. If you had a prostate exam, you paid a small copay.

            Now, they took away copays, which means that money was added to the premium, whether you actually used these services or not. It’s not “free”. Voters were told it was a “war on women” for them to pay $5 to access a long list of birth control. Now instead of paying a few hundred a month in premiums and $500 in deductible, they pay over $1000, with $12,600 deductible, but they have access to 26 forms of birth control without a copay.

            Ponder this difficult question: Were women better off paying a couple hundred monthly premium, a $500 deductible, with a $5 copay for birth control, or are they better off now paying $1200 monthly premium, $12,600 deductible, but no copay?

            That woman can’t afford to buy food now, but at least she doesn’t pay a copay for 26 forms of birth control! Thanks, politicians, for waging war on the affordability of healthcare on behalf of my gender. Now, women are stuck in poverty. If they lose their subsidies, they can’t afford Obamacare. They have an incentive to turn down jobs, raises, and promotions.

            Politicians! Stop helping us! We cannot afford your ignorant meddling.

            1. If you premiums are going up faster after the ACA then under W. Bush, I suggest you start doing more research on your insurance company.

              As for subsidies, you have been subsidizing emergency room costs for years, and it is very expensive for all of us.

              1. SteveJ:

                I’m going to teach you a neat math trick.

                Politicians only talk about the percentage rate of increase going down. If you increase the cost of a premium from $1 to $2, that’s a 100% increase. It’s only a dollar. It’s affordable. There is no reason to believe that it will continue to double annually. They could double that premium for a decade, get it to an affordable level, and leave it there. In this hypothetical example, that percent increase would be shocking, but by the time it leveled off, it would be $1 to $2, $2 to $4, $4 to $8, $8 to $16, $16 to $32, $32 to $64, $64 to $128, $128 to $256, $256 to $512, $512 to $1,024. If it then stayed at $1024, that would be far more affordable than what Obamacare saddled us with.

                Over the past two decades, premiums and deductibles did increase, but the dollar amount was not that much.

                Before Obamacare hit, I was paying around a couple hundred in premiums, and $500 deductible.

                Obamacare made the deductible go from $500 to $6,000. That’s an 1100% increase. That was the big jump. After that, the percent increase was less, but since it was multiplied by a huge dollar amount, the dollar amount of those increases were not affordable.

                $500 to $6000 = 1100% increase, $5500 difference
                $6000 to $12000 = 100% increase, $6000 difference. (Note how the percent increase is a lot less than that first jump, but the dollar amount is enormous. A politician can truthfully say the percent increase is way down, but the dollar increase is actually more.)
                $12,000 to $12,600 = 5%. Now, that’s only a 5% increase, or $600 difference. A politician can then brag that % increases went way down to 5%. Hurray! Except, if you understand the math, that increase is more than what the entire deductible was prior to Obamacare.

                This is how politicians take advantage of people who are not savvy. They hear that lower %, and think they are better off. They are not.

                In a hypothetical scenario, a politician could say he was campaigning to stop the decade long doubling of deductibles. It was slated to be increased for a total of 10 years. He could say that comparatively, Obamacare stopped that rise, as it’s only 5% that last jump. But if you compare the dollar amount, the former deductible was $1024, while the Obamacare one was $12,600. You are worse off.

              2. Steve, when you say someone is subsidizing emergency room costs, specifically what do you mean by subsidizing and spcifically in what way is that happening? How has Obamacare reduced those costs? What makes the Obamacare type of subsidy an improved form of subsidy?

                1. When someone goes to the emergency room and they don’t pay, we do. It is a very expensive form of care. People have had to use it for non-life threatening situations, but still situations that are severe and would be better treated with a doctors visit.

                  The subsidy we pay for the emergency room care of others who do not pay is 100% The same with hospital stays for people who will not eventually pay.

                  1. “When someone goes to the emergency room and they don’t pay, we do.”

                    When someone goes to the ER under Obamacare and is subsidized we pay. When the ER loses money it is made up from the rest of the hospital which we pay. ER visits did not fall as intended. The same people are still being subsidized. Illegals are also being subsidized.

                    Middle class working Americans on Obamacare are paying more than the actuarial rate because they end up subsidizing those on Obamacare. ER fees are extraordinarily high.

                    Outpatient emergiclinics charges can be fractions of hospital ER charges for the same treatments. There is a disparity in payments between hospitals and private outpatient clinics. At least in the recent past colonoscopy payments as an outpatient could be near half of what an inpatient colonoscopy cost. Hospitals are buying up physician practices and when that happens the hospitals are reimbursed more for the same physicians care than before. Surgiclinics have been bought up by hospitals where the hospital buys in and since the payments increase the physician revenues from the clinic continue to be the same. I added these things because Obamacare has increased consolidation and that increases prices and decreases the patients options.

                    Obamacare did not reduce total costs. It increased them while transferring some of the costs to others. It is an absolute failure.

                    Your argument regarding regarding Obamacare savings are false.

          3. The reason medical bills have risen is because neither political party will address the issue of health care costs which have little to do with your analysis and

            Greed by clinicians, hospital administrators and patients alike all take advantage of the system.

            Complacency by patients failing to practice self-care results in chronic medical illnesses which account for the majority of health care costs, e.g. obesity, heart disease, metabolic disorders like Type II diabetes, sedentary lifestyle (orthopedic problems), and on and on and on.

            Manipulation by politicians much like LBJ did with the “war on poverty” scheme. Hillary, Obama, Pelosi all use the health care system to scare Americans, give Americans a sense of safety that the govt will take care of them, and driving up costs. Regulations in medicine drive health care costs exponentially.

            everything to do with increasing the demand curve resulting in the price going up as well as an increase in unnecessary procedures.

            The “demand curve” is chronic medical illnesses that are self-inflicted.

            Unnecessary procedures are performed by greedy clinicians and administrators and complacent patients who could have prevented that cardiac catheterization had they lost weight, stopped smoking, exercised, and on and on and on

            In summary, this conversation goes no where because Americans do not want to be honest, look within and ask themselves why they are so sick, far sicker today than 50 years ago. Age has nothing to do with it

        2. Estovir, How people choose to live their lives is their problem, not society’s. You have an opinion regarding diet. Follow it but don’t make everyone else follow yours. If one wishes to be vegetarian let them be vegetarian but don’t force society into one mold. I am not saying you are vegetarian but there are people and some evidence saying vegetarian diets are better. Whether true or not is unknown.

          “preventative medicine is the single most important factor that can drive down costs.”

          I assume you mean lay preventative medicine but I don’t know if what you say is correct even if limited to lay preventitive medicine. If you are talking about physician preventative medicine then what else but vaccines have done that?

          Being healthy doesn’t necessarily lead to lower societal costs. You should recognize that. Take smokers. They die early and if one runs the numbers they save society a lot of money along with paying for their habit through taxes. They forgo Medicare and Social security payments. Everyone dies so all have to incur that cost. Smokers just die earlier.

          “Most chronic medical problems are due to lifestyle choices.”

          Many chronic medical problems are due to good medical care. If one doesn’t survive a heart attack one will not develop congestive heart failure. That I believe is one reason why years ago (at least) we had more congestive heart failure than out western counterparts.

          1. Many chronic medical problems are due to good medical care.

            Many? what are your sources? lets remember we have a population in America of 329+ Million so lets use percentages vs “many”

            due to good medical care?

            For example?

            Chronic is not acute. There is a difference.

            If one doesn’t survive a heart attack one will not develop congestive heart failure. That I believe is one reason why years ago (at least) we had more congestive heart failure than out western counterparts.

            If you don’t survive a heart attack you’re dead. If you survive a heart attack you may or may not suffer chronic heart failure, which is not the same as acute heart failure.

            Heart attacks are an acute event, not chronic.

            I dont chastise anyone for having this conversation. I wish more patients took an interest in educating themselves. However it is important to know terms, healthy medicine (physiology, anatomy, histology, etc) as well as pathology (sickness of body)

            It is a complex topic but everyone should have an interest in learning.

            Start here:

            Acute Heart Failure: Definition, Classification and Epidemiology

            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597697/

            Acute heart failure is a clinical syndrome characterised by signs and symptoms of fluid overload which require hospitalisation. Patients may present with AHF as the first presentation of heart disease but more commonly as decompensation of a pre-existing cardiomyopathy. In the latter case, admission to hospital represents a significant prognostic event in the natural history of cardiomyopathy as it is associated with worsening mortality and morbidity. The classification and subsequent treatment strategies have focussed on the management of the initial haemodynamic disturbances in a population often with multiple medical co-morbidities. However, in contrast to chronic stable heart failure, little has materialised in the way of therapies that improve long-term survival following admission with AHF. If future clinical trials are to bear fruit, their design and conduct must be done with a more comprehensive understanding of the pathophysiology and with better definition of the patient population.

            All very true

            1. Estovir, read what I wrote not what you think was written.
              1) I dealt with choice
              2) I dealt with fallacies of thought regarding preventative medicine (where a physician NEED be involved.)

              3) >>“Most chronic medical problems are due to lifestyle choices.”

              >>”Many CHRONIC medical problems are due to good medical care.”

              I priovided an example to the question, ‘why’. This is based on questions raised years ago regarding the aggressive treatment by American physicians. The question was why so many Americans had CHRONIC congestive heart failure (along with other things) compared to many western nations. One of the reasons was that American medical care was saving lives and provided more advanced treatments. An acute heart attack damages the muscle of the heart and when the damage is significant the patient can develop congestive heart failure. American medicine was saving more lives from this disease and its sequella. Therefore, CHRONIC heart failure increased. Dead people do not develop CHRONIC heart failure.

              I did not mention acute heart failure. I was discussing chronic disease. Advanced medical treatments can save lives and convert acute conditions to chronic ones. Chronic is a condition that remains with a patient for a long period of time.

            2. Estovir, below is a video you and everyone else will enjoy. It has to do with your thesis of healthy living. I agree patients should live healthy lives but I don’t agree with force.

              The video is short and funny. If one doesn’t like it one doesn’t have a sense of humor.

              1. Hysterical. Bill Maher is a piece of work.

                Trends are important when making medical conclusions. Sure a few thin people die despite their active interventions but other underlying issues not discussed are usually at play. Jim Fixx is one of those people

                His son, John Fixx, was interviewed here:

                If Fixx’s name sounds familiar, there’s a reason. His father, Jim Fixx, wrote “The Complete Book of Running,” a 1977 bestseller that helped fuel the running craze. John was 23 in 1984, just out of college, when his father died of a heart attack at 52 while out on a run. Jim Fixx had taken up running in midlife, lost weight and quit smoking, but apparently it was too late to outrun his family history: his father, Calvin Fixx, suffered his first heart attack at 36, then had a second one seven years later that killed him.

                https://www.washingtonpost.com/national/health-science/bad-genes-dont-mean-you-are-doomed-to-heart-disease-and-early-death/2018/02/23/ddf19a78-0b73-11e8-8890-372e2047c935_story.html

                Jim Foxx also had cardiomegaly, inherited heart disease (Familial hypercholesterolemia) and ignored his recurrent symptoms of chest pain until the last presentation which was the big one.

                The last sentence in the following article applies to many Americans if not most

                On July 21, 1984, best-selling author James F. Fixx collapsed and died of a heart attack while he was running (Gross, 1984). The irony of his death escaped no one. The 52-year-old Fixx had penned the single most successful running book of the era, The Complete Book of Running (1978). In the book he touted the health-giving benefits of running and claimed that regular running offered virtual immunity to heart disease. Fixx’s book sold half a million hardback copies in the United States in less than 9 months reaching number one on the New York Times book list (Lehmann-Haupt, 1978; Pace, 1978) . (1)

                Fixx, an overweight 35-year-old with a high-powered but stressful and sedentary job as a magazine editor, began running in the fall of 1968 after he had pulled a muscle playing tennis. He recalled, “my body had betrayed me, and I was angry” (1978, p. xvi). He began running, ostensibly to strengthen his legs, but the health of his heart was always on his mind. Fixx’s father, Calvin Fixx, suffered a heart attack at the age of 35 years, and Fixx was determined to avoid that same fate. Moreover, he was determined to live his life to its fullest. The elder Fixx survived the heart attack, but, according to his son, “until he died eight years later he lived the life of an invalid…. He sat quietly, read, listened to music and…put his affairs in order” (p. 226). The image of his father as an invalid represented to the younger Fixx a life that was hardly better than death.

                Running was Fixx’s solution to the question of how to live a long and good life. Although noting that, “doctors are cautious about asserting that running guarantees a long life” (Fixx, 1978, p. 227), he also observed that the “proliferation of postcardiac exercise classes” was an indication that many doctors were convinced “regular physical activity is associated with…reduced morbidity and mortality from ischemic heart disease” (p. 230).

                Fixx was equally convinced of the psychological benefits of running. To summarize his position, he cited Mark Hanson, a runner from New Jersey. “To run is to live. Everything else is just waiting” (Fixx, 1978, p. 15). Fixx also described his own psychological changes. “Something in running has a uniquely salutary effect on the mind,” he said (1978, p. xix). He found he “was calmer and less anxious…could concentrate more easily and for longer periods…[was] more in control of [his] life…less easily rattled by unexpected frustrations” (p. xviii). These psychological changes gave Fixx a “sense of quiet power, and if at any time I felt this power slipping away I could instantly call it back by going out running” (p. xviii).

                Puzzling information emerged following Fixx’s death. Friends and family reported that Fixx had complained of “chest pains while running” (Schanberg, 1984, p. 23) and tightness in his chest (Cooper, 1985; Wallis, 1984).Yet he refused to have an exercise stress test, despite the urging of his former wife, Alice Cashman Fixx, and the invitation of Kenneth Cooper (Cooper, 1985; “Deadly Refusal,” 1984). Apparently, Fixx preferred to heed the advice of another physician friend who told him:

                Annual physicals are a waste of time. …

                Darcy C. Plymire (2002) Running, Heart Disease, and the Ironic Death of Jim Fixx, Research Quarterly for Exercise and Sport, 73:1, 38-46, DOI: 10.1080/02701367.2002.10608990

                1. Estovir – Jim Fixx is a life lesson to us all not to be out running every day. Running kills!!!!

                2. Estovir, no one is saying a healthy lifestyle doesn’t increase longevity, however do not make more of the healthy lifestyle than there is. There are genetic causes, accidents and a whole host of other things that prolong life. Medicine is not the biggest life saver in the last hundred plus years, sannitation is. The reasonably healthy individual can increase his lifespan but the question is by how much… weeks, months or years? That is a question where limited studies have been done so don’t make any wild assumptions.

                  The most important things to do are not to smoke, drink excessively or take drugs. If one doesn’t have a history or family history of diabetes or heart disease the weight will play a part but not as great as many believe unless they are terribly overweight. Moderate excercise is a good thing for more than preventing heart disease etc.

                  The big worry we should have is childhood obesity. I proposed a bill to Congress that all fast food restaurants should be on the fifth floor or higher in a building without an elevator.:-)

    2. Glad you personally are feeling better. The actuarial pools are still unstable.

    3. The issue isn’t ¨muddled.¨ The government does not have the power to force citizens to buy anything…period.

    4. Paul:

      They should have targeted help to the poor who could not afford insurance. They should have improved their access to quality health care.

      Instead, they took away access to health care from the unsubsidized middle class.

      Did you know that the family deductible for an Obamacare policy in CA is now $12,000? This is for a middle class family. Not a single doctor I ever went to accepted Obamacare. I used to take pictures of the “we don’t accept Obamacare” signs in the lobby for my friends who doubted me.

      Did you know most major cancer treatment hospitals don’t accept Obamacare?

      Did you know that Obamacare caused drug formularies to tighten, and the loss of off formulary benefits? Insurance used to pay some of the cost of drugs that were not on their formulary. Now, it’s all out of pocket, and won’t count towards your max caps.

      Did you know that insurance companies are leaving Exchanges in droves because Obamacare made them lose too much money, even when charging astronomical rates? There are now Exchanges with zero or one insurer.

      I’m glad that you got your surgery. They could have targeted people in your scenario to help them, without hurting others. You still don’t have access to the same standard of care as someone on an employer policy.

      Don’t you want access to the best doctors if you get cancer?

      Don’t you care that because of Obamacare, the unsubsidized middle class cannot afford their insurance?

      Don’t you want consumers to have a choice in plans? Obamacare is all the same plan, just as slightly different premium/deductible distribution.

      It is unethical to hurt one group of people to try to help another. It is unethical to promise one group of people access to the same quality of care as an employer policy, but instead deliver county level care.

      coveredca.gov

      An unsubsidized policy for a family of 3 on the Covered CA website generates 2020 pricing of a monthly premium ranging from $944 to $1262, with deductibles of $12,600. This is for a policy that literally no doctor I ever went to would accept! Most cancer treatment centers won’t accept it. Out of state treatment centers won’t accept it. This is the most expensive, useless piece of excrement that any politician has ever inflicted upon a populace not savvy enough to stop them.

      When Obamacare first hit, the percentage increase was astronomical. Now, the percentage increase is lower year to year than in the first few, but that percentage is taken from a much higher number than 10 years ago.

      For instance:

      Increasing a deductible from $100 to $500 is a 400% increase.

      Increasing a deductible from $500 to $6000 is a 1100% increase. The difference is $5500.

      Increasing a deductible from $6000 to $12000 is a 100% increase. The difference is $6000

      Increasing a deductible from $12,000 to $12,600 is only a 5% increase. It’s still $600.

      One should note that politicians will always talk about the percent increases. They will declare that the percent increase is slowing down, and it is, percentage wise. But 100% of $6000 is still more money in total than 1100% of $500.

      The middle class cannot afford us. Politicians royally screwed us over, and then lied to employer policy holders, who were mostly shielded from the Extinction Level Event of individual access to health care. They lied and told them Obamacare was just wonderful.

      Now, they admit that healthcare is more unaffordable than ever. But it’s not the Democrats’ fault! They swear! It’s not like their voters will ask if it’s their fault. No, it’s the fault of the evil insurance companies. They must demolish them and meddle even more!

  18. “[t]he individual mandate is unconstitutional because it can no longer be read as a tax”

    As it can “no longer” be read as a tax, it follows that there was a time when it could be read as a tax.

    Can anyone fill me in on what set of circumstances changed since Roberts said it was a tax?

    2. If the Supreme Court says the sky is red, then is it red? Only a leftist idiot would call a legal ¨mandate¨ to buy a service a ¨tax.¨

  19. This is what happens when legislation affecting all the citizens is pushed through without bipartisan agreement and without careful review of what the legislation says. Take note of the famous quote “We have to pass it in order to know what is in it.”

    Democrats have a long history of such stupidity and now they are ripping up the Constitution again with impeachment. Its about a decade since Obamacare was passed. How long will this impeachment remain as an impediment to good government?

    1. Most of the legislation including the mandate was based on the Heritage foundation plan for which there was minimal Republican opposition. When Obama co-opted it, the Heritage foundation “changed its mind.” as did the Republicans.

      1. Steve, the Heritage Foundation has nothing to do with the actual passage of laws. That is up to Congress and they are responsible for what they do. They failed or at least the Democratic portion of Congress failed.

        That the Heritage Foundation made a mistake and admitted it doesn’t change the blundering of our various representatives which include both sides. I know a lot of Republicans and some Democrats that disagreed with the initial viewpoint of the Heritage Foundation. Republicans fought against the entire bill that contained the mandate.

        The bill was passed without adequate review because the Democratic leaders felt that was the only way the bill would survive. They were right and won, but the American people lost.

        I’m not quite sure of what your point was.

        1. Well come on Allan. The Heritage foundation “made a mistake” and Republicans followed suit out of politics. Not based on any principles. That point is dripping through my comment. I didn’t think I’d have to explicate it for anybody let alone someone like you.

          1. You’re thesis is that since a fellow at the Heritage Foundation named Rector composed a working paper 26 years ago which included an individual mandate feature, the Heritage Foundation (and thus the Republican Party) is responsible for Obamacare and its dysfunctions. That’s an asinine thesis and only Democratic Party talking-point mills ever advance it.

            1. No that is not my thesis. My thesis that Republicans supported the provisions in the Heritage plan until Obama co-opted them.

              Most of the health care bill was based on Republican initiatives. Not all of it. No bill is ever based on what one what one party wants. But most of it was — which is odd because Republicans were in the minority at the time.

              Republicans did not want to hand Obama a bi-partisan victory. There was nothing more substantive to it than that.

              Kind of puts the Democrats lack of ethics regarding Impeachment to shame doesn’t it.

              1. No that is not my thesis. My thesis that Republicans supported the provisions in the Heritage plan until Obama co-opted them.

                That’s just a lie. Robert Rector isn’t the Heritage Foundation, the Heritage Foundation isn’t the Republican Party, and a sketch of a plan in a 16 year old working paper is not a finished piece of legislation. You had over 200 Republicans in Congress in 2009. Just which of them had made an explicit commitment to Rector’s idea or to a finished plan which incorporated Rector’s idea? C’mon, put up or shut up.

                1. Republicans espoused the ideas in the Heritage plan — and other plans as well. They don’t have to say “I’m espousing the Heritage plan before every comment they make. They wouldn’t do that anyway during debate on the ACA since Heritage along with other Conservative think tanks along with the Republicans “changed their minds.”

                  1. “Republicans espoused the ideas in the Heritage plan”

                    Steve are you saying our politicians should be able to force us to buy goods and services from a private entity? That is what you are saying if you believe the mandate was proper. Should our politicians also force the citizens to buy broccoli?

                  2. SteveJ, among the Republicans who espoused these ideas were Bob Dole in his 1996 campaign, Next Gingrich, and Romney ran it in Massachusetts. The reason they did was that it was a plan which saved the private insurance industry. It included a mandate, which of course expands the pool from high risk to low risk patients and effectively spreading that risk. That’s how Insurance works. Once that was removed, the ACA became top heavy with high risk (previous conditions) insured. That and other sabotaging by the GOP, including passing on setting up exchanges by states, and even cutting down on enrollment dates announcements has made it not even close to what it was designed to be,

                    And still no GOP plan to “replace” it.

                    Ultimately we will have to figure this out as we can’t afford what is by far the most expensive health care in the world. They provide universal care and spend on average 60% of what we do per capita.

                    1. Pure ignorance dominates all the replies that Anon makes. Even Heritage did not support the type of mandate created by ObamaCare. In fact the difference is massive even though the Heritage mandate IMO is not correct unless other things are included. Heritage suggested castastrophic coverage not the expensive coverage provided in ObamaCare. That meant that the bills that could be paid by individuals would have to be paid by them. This leads to much lower costs. It wasn’t financed by a penalty or a tax and the penalty caused the loss of taxpayer tax benefits so the connection between forcing the patient to buy private services was not a legal requirement.

                      Gingirich’s idea of a mandate was also quite different from the mandate forced onto people by ObamaCare. I beleive he was wrong then even though it wasn’t the same mandate.

                      Listening to Anon is like listening to Fractured Fairytales where nothing Anon says can be taken as the truth.

                    2. Pure ignorance dominates all the replies that Anon makes.

                      Anon is a bore, nothing good comes from the perpetual lying and dictatorial relativism that one regurgitates. I never read Anon

                      Peter Shill however is entertaining. My guess he is a she given her vocabulary and simple sentences. Natacha is a mess. I start to ache when I read 2 sentences into her tripe because one can sense the pain she has in her head. Dreadful even if it is all the same rant day after day

                      Coming to this blog is fun escept during those times when it isn’t

                    3. “Anon is a bore, nothing good comes from the perpetual lying and dictatorial relativism that one regurgitates. I never read Anon”

                      Estovir, you are being overly generous to Anon but I understand why one would never read Anon.

            2. DSS, I am glad you further explained the origin of Heritage’s initial mistake and what it actually did or didn’t do.

          2. Steve, What are you talking about? It sounds like your object was to make a case against a group not to clarify a problem. Under some circumstances the mandate may have worked better but not under the Obamacare law that was passed. Besides as written into the law I don’t think the mandate was legal or functional. Justice Roberts to partially remedy the problem made the fine into a tax that both Democrats and Republicans refused to call a tax in the legislation. That poor judgement (IMO) guaranteed problems down the road.

            Sometimes people do not understand the principle they are defending or not defending. That is understandable and that is why people are supposed to deliberate carefully and not just ‘pass it to see what is in it’.

            Yes, you do have to “explicate it” using principle and law and being very clear as to what is being explicated. I think you did not do a good job of doing so. Try again. 🙂

            1. No I think you just got your back up and want to claim the comment is vague.

              Opposing Obama was the reason for Republican opposition. Then they looked for arguments to gloss over that.

              By the way, where is their replacement? In fact, when have they ever proposed anything on this?

              1. “No I think you just got your back up and want to claim the comment is vague.”

                Steve, you make assumptions that are wrong. I want more specifics, not generalities. I am seeing your generalities in other posts I haven’t responded to at this point and the same questions arise.

                I opposed Obamacare but not because of Obama rather because it was a bad bill. There was a tremendous amount of debate about the bill that correctly showed many of the problems we face today. You are copping out and blaming decisions made soley on opposition to Obama. Obamacare should never have been passed but you can’t provide the specifics so you use a generality ‘It was the dislike of Obama that forced Republicans not to vote for Obamacare’. That is BS and you should recognize it.

                “By the way, where is their replacement?”

                Plenty of ideas have made it to the public. Ideas require passage by both parties. Socialized medicine is not the answer so Democrats will not agree to anything unless it leads to it. We will have to pick away at Obamacare gradually replacing parts of it. Not good but it is the best we can get because instead of discussing health care we are discussing impeachment. Some Democrats are too unhappy about losing a legitimate election and waiting until 2020.

                1. I tend to be skeptical of incremental approaches. The current mess is a consequence of 70 years of increments. The trouble is, the Democratic Party is the electoral vehicle of media types, lawyers, educational apparatchiks, and social workers. None of these occupational guilds have in them the people who can design a satisfactory replacement.

                  1. DSS, I am skeptical of incremental approaches but now we have a law in place that makes it even more difficult to pass a decent law. I think health care legislation is doomed to the incremental approach because of its complexity and total impact on costs and society.

                    The best replacement for Obamacare is one that most closely mimics the freemarket.

              2. This has nothing to do with Obama you nut-job. This is entirely about the government forcing me to buy a service I don’t want at a ridiculous price. That is unconstitutional.

      2. It wasn’t ‘based on’ that. Robert Rector of the Heritage Foundation floated a sketch of a plan 16 years earlier which included an individual mandate as a feature. It was never adopted as a policy by any Republican body. It was just an idea out there. And it’s not the same plan, it just has a feature in common.

      3. No, the opposition to a mandate from the government to buy a service was always there and it will always be there. Its also blatantly unconstitutional. Nice try rewriting history.

    2. It wouldn’t matter much if there were bipartisan agreement or not. Either the financing and allocation scheme is sustainable and tends toward a stable equilibrium or it isn’t and doesn’t. The trouble has been for decades that it isn’t, and the results are perverse. We’ve had escalating allocation of resources to medical care and long-term care. Some of that is certainly Maslow’s hierarchy of needs and some of it is cost-disease. Can’t do much about either feature and you shouldn’t. The rest you might be able to address and should. I don’t care if the solution is bipartisan or not, so long as the basket of problems it resolves aren’t of less import than the basket of problems it creates. (Mitt Romney attempted to do that in Massachusetts, a state which had a ruined insurance market consquent to the legislatures MOAR free sh!t disposition).

      1. “It wouldn’t matter much if there were bipartisan agreement or not. ”

        DSS, I don’t think I disagreed with anything you say above. A good bill as I stated requires bipartisan support and “careful review of what the legislation says”. Even then the legislation might turn out not to be workable. That is why working with the free market is better than working with a government bureaucracy.

        1. You’re not going to construct a medical service delivery system or a long-term care system based on fee-for-service market transactions, full stop. You can do that for housing, for groceries, for gardening equipment, for a 1,000 other things. Not medical care and long-term care. You did not have such a system in 1940 and you would have collective revulsion if you tried to erect one. The point is to incorporate market-transactions as an allocative device in a larger structure.

          1. DSS, I didn’t say we could have a pure market system for healthcare. I don’t know of anything that is based purely on the free market system. I did say: “working with the free market is better than working with a government bureaucracy.”

  20. I thought this issue was already settled in the Supreme Court, for good or ill.

    The problem with Obamacare is that has a tendency to generate unstable actuarial pools. You’ve had serial efforts at contriving a structure for the finance of medical care and long-term care reviewed by lawyers (a commonly innumerate occupational group) and drafted by people like Louise Slaughter listening to insurance industry lobbyists and to constituents who think only of their own household budgets. Most interventions into the market for insurance services by Congress in the last fifty-odd years have generated trouble they had to clean up later (if they could manage to clean it up). There are some solutions to the dilemmas we face, but those executing collective action would have to understand that no schema for financing medical care is going to be without defects which injure some constituency.

    1. “The problem with Obamacare is that has a tendency to generate unstable actuarial pools.”

      DSS, that was well known and discussed before Obamacare was passed. Dreams won over reality and now the problem will keep popping up.

    2. Not with the rogue judges of the 9th Circuit running free and since when did they abide by the Constitution or the rulings of the Supreme Court? ACLUeless Soristas everyone.

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