SCOTUS and HCR: thinking it over
Not yet, but soon, the Supreme Court finally will be issuing its long-awaited ruling on HCR.
When? By the end of the month, and speculation abounds.
I won’t even try to predict what will happen; I’ve discussed the legal issues with HCR many times before.
I will say, however, that I think this article in the WaPo by Robert Samuelson neatly summarizes some of the major political and economic errors Obama was making when he pushed HCR:
(1) It increases uncertainty and decreases confidence when recovery from the Great Recession requires more confidence and less uncertainty…
(2) The ACA discourages job creation by raising the price of hiring…
(3) Uncontrolled health spending is the U.S. system’s main problem ”” and the ACA makes it worse…
(4) Obama’s program also worsens the federal budget problem.
To all of this, I’ll add that the methods by which HCR was passed went a long way toward adding to the people’s outrage.
Samuelson writes:
To all the ACA’s substantive defects is now added a looming political and constitutional firestorm. Whether the Supreme Court upholds the whole law, strikes it all down or discards only parts, anger and outrage will ensue. The court may be accused of usurping legislative powers or of cowering before White House intimidation. The ACA has become an instrument of the political polarization that the president regularly deplores.
Ah, but I would assert that although Obama “regularly deplores” it, he actually welcomes it. He would like it even better, of course, if everyone just agreed with him. But even Obama’s narcissism must recognize that’s not likely, and so the next best thing is political polarization and anger. All true Alinskyites would be proud.
And of course, Cloward and Piven would say that Samuelson’s four points are a feature, not a bug.
[NOTE: While researching this post, I came across a very curious article.
It’s curious not in that the writer uses her own personal tale of woe to highlight the callous cruelty of those who would challenge the HCR law. It’s curious in that it ignores and/or misstates several rather obvious facts—although, come to think of it, that’s not really so very curious either, is it?
The author is a young woman in her 20s named Selene Soria who claims that she is in constant pain because she lacks the money to pay for her wisdom tooth extraction which will cost $20,000. Now, the cost of everything has gone up in recent years, but there’s no place in the US where a wisdom tooth extraction would be anywhere near that figure. Even $2,000—which could be what Soria meant, because what’s a zero here and there—would be quite high for that particular procedure.
What’s more, Soria is already a Medicaid recipient. What led her to qualify for that benefit remains unspecified, but she is adamant that it should include dental as well. What’s more, it might end up doing so:
In the medical program that provides me with a caretaker and other services for other medical problems, I have a social worker assigned to my case. She has been trying to get the approval from the state so that I can use some of the funds allocated to my case to pay for my dental procedure.
The process started back in September of last year and last month I was notified that all the paperwork required for approval was sent to the state. All I had to do was wait and that is what I have been doing. In the meantime, the pain comes and goes.
I bet that to a lot of middle class people that sounds like a pretty good deal.
But that’s not all. Soria seems to be unaware that dental benefits are not included in HCR. Nor does she seem to know that regular dental insurance does not always cover wisdom tooth extraction.]
Soria could be stupid or lying or both.
It’s truth in that it will help the cause, so her article stands and is likely effective.
I’m getting my wisdom teeth out Thursday. $150 copay with BCBS and the procedure is estimated to cost around $2000. If I had to pay cash, I wonder what the actual cost would be. We have no idea since the health care system doesn’t use real costs anymore. It’s all made-up and revolves around reimbursements and coding.
holmes: if you had to pay cash, the cost would be considerably less. The discount varies, but ordinarily it’s not insignificant. It seems as though you are having one of the more complex procedures; there’s a lot of variation on how big a deal it is to extract wisdom teeth.
Good luck!
If we all had to pay cash for our medical care: (1) most of us would exercise more, (2) most of us would eat better, (3) most of us would lose weight and (4) most of the remaining smokers would quit. Those who could not do the foregoing would suffer. Because we’d skip or put off treatments due to the cost, the demand for medical care would go down, and consequently, the price for medical care would go down. In addition, because of (1) (2) (3) and (4), we would soon become a nation of healthier people, and consequently, the demand for medical care and the cost of medical care would decline even further.
Of course, very few have the cash to pay for the big medical bills. But everybody has some money, even the poorest. Rather than impose a single-payer system, maybe we could institute a system whereby we paid for various items of medical care as a percentage of our income. For example, if a given procedure cost $2,500, then for a poor person, maybe it could be $250, but for some who made 100 times as much, it could cost $25,000.
Sounds complicated, but it would be better than all of us becoming wards of the state.
Silly woman. If she is on medicaid she would not qualify for Obamacare anyway. In fact, they might well cut her benefits to spread the money around.
I find it instructive that someone who is already receiving all sorts of support from the government at no charge is so upset about one service she is not receiving. Her situation seems to have created a strong sense of entitlement.
A good example is MRI’s. Insurance paid MRI’s are somewhere around $1000 or $1500. But, with cash, I can go in and negotiate an MRI for $150.
Going back to SCOTUS and HCR:
The moronic aides who wrote the filibuster of a 2700 page law took out the severability clause. In my untrained legal mind, that was the progressives’ mistake. They were in such a hurry to get that bill passed by hook or by crook with backroom deals and cutting the Republicans out of the writing process of the bill itself. The mandate is the Congressional overreach on which the Court will rule. Reading tea leaves, the mandate doesn’t look to survive. Without the mandate, the heart of the law is gone. And without severability, it is not the Court’s job to pick and choose from such a clusterfu*k of a law what will remain and what will go. Also the comment from one of the Justices asking if anyone expects them to read the 2700 page law (Congress didn’t, so why should the Court?).
My hope is the Court states clearly why this law in unconstitutional, throw it out in its entirety, telling Congress to do it right the next time. That would be a sweet Nancy Pelousy smackdown.
Rusty- if I were governor of a state, I would impose a minimum deductible requirement, but make it inverse to income/wealth. upper middle class and the wealth= really high deductibles (say, $5k to $10k), and moving down into lower deductibles down to $1000 or so (indexed to inflation). This would turn insurance into actual insurance and require people to use discretion (market forces you mention).
I would also have a public option for the working poor (who often don’t qualify for Medicaid). They just need access to some care. I’d rather spend money on the working poor than the nonworking poor, to be honest.
I don’t have dental insurance. Last January my dentist and I decided that repairing my bad wisdom tooth was a lost cause and decided on extraction. I paid cash, and it cost me $163.00. That’s it. Procedure D7140 – Extraction, Erupted Tooth, or Exposed.
David Davies: yes, simple extractions are one of the cheapest dental procedures around. But if wisdom teeth are impacted, their removal can cost considerably more.
Considerably more—but nothing even remotely like the figure this woman cites.
Curtis: I don’t know where you live, but that sure isn’t possible where I live. I have catastrophic insurance and pay out of pocket for most things, and I had an MRI that I paid for a couple of years ago. It would have cost $3000 with insurance, and were only willing to take 20% off without insurance, for a cash payment.
Hey, that reminds me, Davy Day: I had a W tooth that went viral. Should have paid attention because for about a week it was hanging up in there in the stratosphere but when it came down, put my ass in the ground, I am telling you.
But I live in Suthern Cal, the land of Aisan dentists, one on every corner. They’ll do needed work cheeep.
I found a puller in four hours, being heavily motivated to do so. He pulled and I paid: 85 dollar. I wrote a letter of thanks and began to floss and brush jess sa little more.
New book out from Scalia in which he reports he’s none too fond of Wickard v Filburn. Might think of overtarnin the whole damned commerce clause presumption.
That’s a shame, Neo. That’s way too high for an MRI.
I guess you need to come to Southern Cal and I’ll set you up for an MRI or even CRT. Our office gets overcharged all the time on MRI’s because we obtain services for clients on a lien basis which are more expensive because the provider doesn’t get paid until we win our case. Still, MRI’s on this basis cost, at most, $1500. I’ll pdf you the bills to prove it. My last guy had two of them before his epidurals. (Don’t waste your time on epi’s. Go straight to surgery. Especially if you’re older. They doing great microsurgery. Then, of course, control the inflammation through diet and exercise therapy. I do hope you have experienced the end of painful illness and/or injury.)
http://www.spine-health.com/video/microdiscectomy-surgery-video-a-spine-surgeon-explains-procedure
Now, as for the $150 claim, that was given to me by my chiropractor. There are a lot of machines down here not being fully used. You go in with cash and say here it is and I need an MRI. That $150 represents money right there, right then, free of paperwork. Someone will take it. States vary greatly. California is liberal in this area and that is an exception. Oregon is liberal. Washington not. I’ve talked with chiropractors and orthopedic surgeons, directors and workers at MRI units trying to find the best deal. I have a “subluxation” probably better defined as a 3mm bulge of C4 and C5 and with stress it triggers horrendous sinus headaches so damn bad I sometimes bang my head against the wall. Nothing makes it go away.
So, anyway, pain brings research and clarity.
Am I right on this ?Don Carlos.
I meant CT, not CRT. Must have had Critical Race Theory on my mind.
http://en.wikipedia.org/wiki/X-ray_microtomography
The whole HCR goes away when we ban the horrendous idea of retirement. At what age do we “retire” from life. Are you kidding me. You either have won the day through the accumulation of property, or you keep contributing.
And the funny thing is, those who won their day, don’t retire. Isn’t that what you see.
Retirement. Don’t accept it. It’s a lie. Meant to tell you that you cannot contribute as you age. What a fucking lie. When all the wisdom and talent and craft has been refined, and then, to say: No way.
Well: Bull shit.
Take government out of the equation and everything changes, even in this time of high tech medical miracles. Take government out of education, medicine, and every other area of our daily lives and society will flourish; allow government to meddle and dictate and society flounders. Its all rather simple. Either people determine what is best at the local level or DC bureaucrats and political whores mandate what is best for themselves. Its an either or proposition. There is no grey area, its either them or us.
“Government is not reason, it is not eloquence, it is force; like fire, a troublesome servant and a fearful master. Never for a moment should it be left to irresponsible action.”
George Washington
The country doctor rambles….
http://www.youtube.com/watch?v=lw9dZNdOKV4
“Retirement. Don’t accept it. It’s a lie. Meant to tell you that you cannot contribute as you age. What a fucking lie.”
I’m still working. But for the summer I am off duty and now back in Iowa after 10 days in Montana working in the garden, growing food for the table and before too long the canning jar. And I’m honing my marksmanship skills once a week. I can still put a 5 shot group at 100 yards in the center ring with my Mauser. I reload 38, 357, and 8MM. Retirement is for me just another phase of working. 😉
>>>> Nor does she seem to know that regular dental insurance does not always cover wisdom tooth extraction.
In my own experience, “Dental Insurance” is an utter scam. It covers cleaning and “catastrophic” problems most of the time (i.e., getting a tooth knocked out). It’s exceptionally rare that it actually covers any kind of non-accidental issue. And I’ll bet any policy that does is a lot more expensive than a standard DI policy.
I read Soria’s article. It’s possible that she is one of those artificial people liberals talk about to prove their point. I believe it was Al Gore, or maybe JFKerry who would orate about the pitiful situation some composite (?) character suffered under. Usually it was claimed that they couldn’t afford their medication, or lost their home due to some unfortunate insurance snafu.
On the other hand, Soria seems to have other medical problems, a caretaker, etc. It is possible that her individual medical problems would necessitate her extractions to be performed in a hospital, as she claims, in which case, $20 grand would not be unreasonable.
Soria could be stupid or lying or both.
Or put more succinctly, she’s a Democrat.
But seriously, is there any reason whatsoever to believe she actually exists? My bet is that she’s Lucy Ramirez’s sister, or a “composite.” And if she does exist, is there any reason to think she’s here legally?
I refuse to give the slightest credence to any agitprop stories unless the proffered facts and dramatis personae are thoroughly proven to exist.
This policy saves a lot of time.
Employeer provided insurance drives up health care costs. The reason: there is no price competition at point of service.
Insurance for routine healthcare makes no sense in a rational marketplace; the reason it is done is because of the tax code.