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Reuters reports that the US Supreme Court has ruled 6 - 3 in favor of the nationwide availability of tax subsidies that are crucial to the implementation of President Barack Obama's signature healthcare law, handing a major victory to the President. It marked the second time in three years that the high court ruled against a major challenge to the law brought by conservatives seeking to gut it. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," wrote Chief Justice Roberts, who added that nationwide availability of the credits is required to "avoid the type of calamitous result that Congress plainly meant to avoid." The ruling will come as a major relief to Obama as he seeks to ensure that his legacy legislative achievement is implemented effectively and survives political and legal attacks before he leaves office in January 2017.
Justice Antonin Scalia took the relatively rare step of reading a summary of his dissenting opinion from the bench. "We really should start calling the law SCOTUScare," said Scalia, referencing the court's earlier decision upholding the constitutionality of the law (SCOTUS is the acronym for the Supreme Court of the United States).
Original Submission
(Score: 5, Insightful) by Thexalon on Thursday June 25 2015, @05:01PM
If you accept that as an axiom, then the only logical political system is anarchy. And that means that the best country in the world to live in should be one with either no government at all (e.g. Somalia) or a completely dysfunctional government (e.g. Iraq, Syria, Afghanistan). Since those kinds of countries are demonstrably not the best countries to live in (measured by GDP per capita, life expectancy, education level, and a whole lot of other measures), that seems like a fundamentally flawed assumption to make. Sometimes government gets it right or at least really close to right (e.g. municipal water supplies), sometimes government gets it wrong (e.g. Fast and Furious), and failing to praise it when it gets things right is just as incorrect as failing to criticize it when it gets things wrong.
As for the rest of your argument, you are conveniently ignoring several aspects of the ACA that prevent your doomsday scenario:
1. It's still a competitive marketplace, so insurance companies are motivated to keep their costs down. As in, if your subsidy is $80 per month, your subsidy is $80 regardless of whether you pay $150 a month for insurance or $450 a month in insurance, which will motivate insurers to keep the prices down.
2. The 85% rule demands that the insurance companies spend at least 85% of what they take in on actual health care. That means that any savings that the insurance company is able to eke out of the vendors will be immediately reflected in the pricing.
3. Insurance companies can and do have leverage to negotiate with health care providers to keep prices down in a way that individuals do not. That helps the price of the initial health care no longer spiral out of control.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 1) by enigma32 on Thursday June 25 2015, @05:09PM
3. Insurance companies can and do have leverage to negotiate with health care providers to keep prices down in a way that individuals do not. That helps the price of the initial health care no longer spiral out of control.
Have you ever actually gone to a doctor before?
Have you ever seen the price difference between paying yourself and paying through insurance?
Anecdotally speaking (based on my own experience and experiences friends have shared with me), the same care seems to cost 2-3x more when the insurance company is paying than when you pay out of pocket. You're saying that's them keeping the price of healthcare from spiraling out of control?
(Score: 5, Informative) by vux984 on Thursday June 25 2015, @05:29PM
Anecdotally speaking (based on my own experience and experiences friends have shared with me), the same care seems to cost 2-3x more when the insurance company is paying than when you pay out of pocket.
Meanwhile...
http://www.jhsph.edu/news/news-releases/2007/anderson-hospital-charges.html [jhsph.edu]
So it clearly goes both ways.
(Score: 1, Insightful) by Anonymous Coward on Thursday June 25 2015, @05:34PM
This is the thing. It *depends* on where you go.
Most of the people I have been dealing with are willing to give me a break if I do 3 things. I pay up front with cash (or something close), no credit card, and no insurance. If you are dealing with a conglomerate company their prices are determined by the head office (meaning no breaks). But if you are dealing with a 'mom and pop' practice you can get some good discounts. They *reallllllly* do not like dealing with insurance. You think you hate it? They deal with it day in and day out.
(Score: 1) by enigma32 on Thursday June 25 2015, @05:34PM
Touché.
That's very interesting. I wish there was a link to the research.
It's not entirely clear whether he means the total cost of care is less with insurance or the out-of-pocket cost is less, though presumably he means the former, since otherwise it's useless drivel.
(Score: 2) by Thexalon on Thursday June 25 2015, @07:22PM
Yes, in the last year.
Yes. And I've seen both the insured and uninsured prices for the same procedures. The prices were somewhat lower with insurance, even factoring in the costs of insurance.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 3, Interesting) by Runaway1956 on Thursday June 25 2015, @05:18PM
Uh-huh. Makes sense, doesn't it? Except, I'm paying more today than I paid two years ago. My employer and my insurance company both blame Obamacare for the increases. Hmmm . . .
Oh yes, I know there are success stories because of Obamacare. Some social worker in Ohio demonstrated that he got health care for hundreds of clients who were un-insurable before Obamacare. So, what does that mean? Subsidies. You, me, and every taxpayer in the nation is paying for those un-insurable people's insurance.
I could maybe go along with that, up to a point. Obama COULD HAVE simply passed a law that no one could be turned down for insurance. No one. If someone applies for insurance, the insurance company has to insure them, at a reasonable rate. First thing that would have happened is, the insurance companies would have jacked up the rates - and I'd be in just about the same place I am now, with a couple rate hikes. Wouldn't that have been much simpler? And, the IRS wouldn't be looking over my shoulder to make sure that I'm insured.
BTW, when I said gubbermint doesn't get ANYTHING right, I was referring to our own government.
The military industrial complex is so very damned expensive for the very same reasons we can expect health care to continue increasing in cost every year from now on. When gubbermint meddles in anything at all, the costs grow exponentially.
(Score: 2) by aristarchus on Thursday June 25 2015, @05:37PM
My employer and my insurance company both blame Obamacare for the increases. Hmmm . . .
And you believe them? Hmmm, we need to get the mental health provisions into Obamacare, Stat!
(Score: 2) by Runaway1956 on Thursday June 25 2015, @05:58PM
Do I believe them? Yes and no. No, I don't believe that they can justify the increased rates. But, I most certainly believe that they can rationalize the increased rates by blaming Obamacare. And, it's working - the rates have been jacked up, and I have little choice but to pay them! Five years ago, I had an option to just drop the damned insurance, today, the law says I don't have that option. Obviously, the rates can be increased by 10, 30, even 100% at the insurance company's whim, each and every year. If I were getting the subsidy, the near-term pain would be masked, but what about five, or ten years from now, when gubbermint turns the subsidies off?
(Score: 0) by Anonymous Coward on Thursday June 25 2015, @05:59PM
Mine has not gone up since Obamacare, for the first time ever.
So there's the opposite anecdote for you.
(Score: 0) by Anonymous Coward on Thursday June 25 2015, @06:20PM
> Mine has not gone up since Obamacare, for the first time ever.
I went from paying $550/month with a $5K deductible and a 30% co-pay to $300/month with a $2K deductible and $10 office-visits and $10 diagnostics.
Former plan was through my employer, later plan was a "gold" plan bought through my state's exchange website.
(Score: 1) by Squidious on Friday June 26 2015, @01:17PM
We are paying the same price as two years ago for much better coverage. No subsidies and complaints here, either.
The terrorists have won, game, set, match. They've scared the people into electing authoritarian regimes.
(Score: 0) by Anonymous Coward on Thursday June 25 2015, @05:39PM
But the obscene rise in health care costs started back between the Clinton and Bush era and has been spiralling upward ever since. Obamacare is certainly a waste and will eventually be proven a historical failure, but it was just a legislative symptom of a much bigger disease running its course through this country. And partisanship is at least one vector it uses to to infect the system.
(Score: 2) by DeathMonkey on Thursday June 25 2015, @05:46PM
Uh-huh. Makes sense, doesn't it? Except, I'm paying more today than I paid two years ago.
And this is totally the ONLY time healthcare costs have ever risen, right?
My employer and my insurance company both blame Obamacare for the increases. Hmmm . . .
Certainly no conflict of interest there...
(Score: 2) by frojack on Thursday June 25 2015, @07:26PM
We were promised that health care costs would DECLINE, you idiot.
http://www.breitbart.com/blog/2013/10/28/video-19-times-obama-promised-to-lower-annual-insurance-premiums-by-2500/ [breitbart.com]
No, you are mistaken. I've always had this sig.
(Score: 4, Insightful) by gishzida on Thursday June 25 2015, @06:14PM
What we got in the ACA was what was "Allowed" by large corporate interests. This is your hard earned "Libertarian Ideals (tm)" in action!
It would have been much better if what had been enacted was true socialized medicine where the "profit motive" had been removed. The "Death Panels" advertized by Republicans, Tea Baggers, and Libertarians are now run by insurance companies instead of ethicists looking for reasonable quality of care and quality of life.
As for subsidies not working or being a failure the answer for me at least is that they work as described. When we enrolled we'd had a really bad year with total income being around $12K... so we got a "deal" of about $76 / mo. for my wife and I... but during the year I got old enough (59 1/2) to cash in some of my 401K savings... When tax time came around I had to "pay back" $1400 to the government since my income was too high for the subsidy received and we had to re-enroll in a "more expensive" plan (about $120 / mo.) .
You complain about what you have to pay for insurance when the truth is your corporate masters are the ones that are screwing you. They make their profit off of your hard work and blame someone else for why they can't pay you a decent wage and proper benefits. To make matters worse they refused to make medical care a public "utility". Why did they do that? So they can make a profit from people's medical issues, disease, and suffering. Don't believe the issue is about "choice". It is about profits. That is the only thing corporations care about.
Much as I dislike the ACA it is better than nothing.
(Score: 1) by khallow on Friday June 26 2015, @04:54AM
This is your hard earned "Libertarian Ideals (tm)" in action!
This is quite true. I doubt there is a leftist idea out there, no matter how stupid, ill-conceived, or self-serving, that we can't cause to fail instantly merely by pointing out that it won't work. Our mental failwaves are simply too strong for you to resist.
(Score: 0) by Anonymous Coward on Thursday June 25 2015, @07:37PM
I believe there are people in the GOP that would love to interview you and go all Fox Newsy about it.
Because they've been looking for a case like that for a long while and couldn't find a single one that stood up to even a little bit of scrutiny.
(Score: 2) by Thexalon on Friday June 26 2015, @01:29PM
Yup, we are. Just like we were before - we used to do so by hospitals overcharging for care to make up for the people that couldn't pay their bills, now we're helping to pay for their insurance. And the least insurable people in the country are also already covered by taxpayers, with Medicare and Medicaid.
What if the someone in question can't afford to pay the "reasonable rate"? Then what do you do?
If your policy goal is to make sure that everybody has insurance, then you need some way of either forcing or incentivizing everybody to have insurance to make sure that those who are not sick can pay for the costs of those who get sick.
The ACA, which is definitely not perfect but much less bad than the way things were before, basically has 3 pieces:
A. Insurers must insure everybody. None of this "first prove you aren't sick, and then we'll let you buy insurance, and if you get sick then we'll cut you off" business that was going on in 2005.
B. Everybody must have insurance. Otherwise, you'll have people only buy insurance when they're sick, which means that the cost of insurance will rise to be more than the cost of health care, which defeats the purpose of having insurance, which means that nobody is better off than before.
C. Subsidies are given out for people who can't afford insurance without help. Otherwise, you're going to have lots of people who both have to have insurance (point B) and can't get it.
That, of course, explains the skyrocketing costs of postage stamps [usnews.com]. By which I mean not-at-all skyrocketing, because the inflation-adjusted price is lower now than it was in the 1970's.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 2, Interesting) by jmorris on Thursday June 25 2015, @05:18PM
If you accept that as an axiom, then the only logical political system is anarchy.
Or you do what the Founding Fathers did and establish a strictly limited Constitutional Republic empowered to do only those things that our current understanding of economics and political science hasn't found a way to handle better down at a lower level of government or in the private sector. And you do it in the clear knowledge that the State will still tend to be a substandard solution and a general drag on society.
Look around, has Fascism worked out here these last hundred years? Has it worked anywhere? Or how about it's kissin' cousin of Socialism? Has it worked? Anywhere? So why not try Americanism again? It worked.
Go read The Federalist Papers, if you can't handle the language read the modern translation Glenn Beck got a college student to produce to help with that problem. Understand what the Old Republic was, why it was designed that way and THEN and only then decide if think it would be likely to work better than the Empire.
(Score: 0) by Anonymous Coward on Thursday June 25 2015, @06:21PM
read the modern translation Glenn Beck got a college student to produce to help with that problem.
Glenn Beck? College student? Translation from English to English? Unpossible!!!
(Score: 2) by jmorris on Thursday June 25 2015, @07:32PM
I read old books, the language of The Federalist Papers is perfectly readable for me but a common complaint is the difficulty of modern government educated people to read it. Most modern writing is on a level that someone of the Founder's era with a sixth grade education would consider pretty dumbed down. So one day, way back when Beck was on FNC he said it would be a wonderful thing if somebody would do a translation to 'Modern English' and a college student heard it and stepped up. Beck had the kid on the show and announced that he would be publishing the book through his imprint and did so. I have now read both and can see how the translated version would be much easier to digest and understand. Nothing appears changed in the meaning of the text but there has been a fair amount of linguistic drift in two centuries, different word choices make sense now, cultural references need footnotes, breaking up long sentences with multiple dependent clauses and so on. Just generally updating the work to match the expectations of a modern audience.
(Score: 5, Interesting) by Thexalon on Thursday June 25 2015, @07:03PM
I'm assuming "here" means the United States. If that's not the case, please let me know.
Since you've decided that everything that's been done by the US government since 1915 is "fascism", then yes, I'd say it worked out extremely well. Some of the achievements of that system:
- Defeating the avowed fascists in Italy and Germany and Japan, and dominating the world militarily.
- Infrastructure such as the Interstate Highway System and airports all over the country.
- Pushed literacy rates above 99.5%, and overall education level to the highest in human history.
- The largest GDP and worker productivity in the world.
- Through scientific research (e.g. human genome project) and public health regulation (e.g. the FDA), helped make the life expectancy in the US from 55 years to 80 years, compared with the 60 years or so in those countries without "fascism".
- Landing people on the moon. No other organization on the planet has even come close to duplicating that.
I can keep going, but generally speaking the US has done damn well under the governments of such noted fascists as Dwight Eisenhower.
You could point out that the US is no longer #1 in a lot of those areas, and you'd be right. The part that you'd be wrong about is that libertarianism helps you in any of that, because the countries doing the better than the US by these kinds of measurements (Finland, France, Sweden, Canada) are run by avowed democratic socialists who pursue policies that are far more left-wing than the US.
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 0) by Anonymous Coward on Thursday June 25 2015, @07:56PM
and dominating the world militarily.
Playing world police is not a virtue.
- Infrastructure such as the Interstate Highway System and airports all over the country.
Very good. Now, if only we could get the TSA thugs out of the airports...
- Pushed literacy rates above 99.5%, and overall education level to the highest in human history.
Literacy is good, obviously. Sadly, schools do not educate; they mostly force people to memorize information. Understanding is not required. Sure, it's better than before, but being better than absolute garbage isn't too much of an accomplishment. We still have a long way to go, and I don't think we're at the top when it comes to education level.
You could point out that the US is no longer #1 in a lot of those areas, and you'd be right.
I know you said this, but I could not resist.