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American Health CareWith all the stuff in the news about Hillary Clinton wanting to socialize health care I decided we need to discuss it here.

I personally think we have the best health care system in the world. If someone (especially someone working in the health care industry) disagrees, I'd like to know why ...
#1  Posted 7 years ago  |  Reply  |  Quote  |  + 2 Cool
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In reply to ChaosAD, #4798:

So maybe a little "Ask not what your country can do for you" is in order, rather than taking it for granted that every single person you meet is an utterly self-centred prick.
#4,801  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Ditto
DiMono Site Admin
In reply to ChaosAD, #4797:

You know what else is up there consistently among the top 5 though? A whole bunch of nations with fully socialized health care. So saying Switzerland's is among the best as if that precludes other systems being as good or better is disingenuous.
#4,802  Posted 3 years ago  |  Reply  |  Quote
In reply to DiMono, #4802:

He does have something of a point though, as "best" systems are strongly dependent on context, and the things that work well for one country might not work so well in another. The discussion is American Health Care, so it could be fair to say that doing a cut and paste of the Canadian system on the American system would be a disaster.
#4,803  Posted 3 years ago  |  Reply  |  Quote
DiMono Site Admin
In reply to swooper74, #4803:

More to the point, a cut-and-paste of the Canadian system would never be accepted.
#4,804  Posted 3 years ago  |  Reply  |  Quote
In reply to DiMono, #4804:

Which is a big part of why it would be a disaster. Practical concerns like, "Could this ever be sold and accepted by its intended audience?" really should be considered when determining what the best system for said audience. So, it's either change the system to fit the audience, change the audience to fit the system, or try to get the two to meet somewhere in the middle. Saying "You guys should do it the way we do it here, duh!" isn't very helpful when the way we do it here is totally unacceptable to the people we're suggesting it to.

Culture matters, and the one lesson that this thread has hammered home time and time again is that American culture is not the same as Canadian, British, Swiss, or any other culture but its own. A society built on a myth of rugged self-reliance, rather than deeply ingrained need for cooperation like we have up here (rugged individualists are thin on the ground when you need to huddle together for warmth 6 months a year) isn't going to run on the same setup, and that needs to be taken into account.
#4,805  Posted 3 years ago  |  Reply  |  Quote
Don't know if this was posted yet.
JUSTICE SCALIA: Mr. Kneedler, what happened to the Eighth Amendment? You really want us to go through these 2,700 pages? (Laughter.) And do you really expect the Court to do that? Or do you expect us to to give this function to our law clerks? Is this not totally unrealistic? That we are going to go through this enormous bill item by item and decide each one?

At first I was like, "If you're going to decide the constitutionality of this bill, shouldn't you be expected to read it all?" But then I thought about it, and he kind of has a point. I doubt every single page is relevant, and that would take someone days to get through.
#4,806  Posted 3 years ago  |  Reply  |  Quote
In reply to Mongopwn, #4806:

Maybe not to read every single page, but you would think they should know the contents of the bill before trying to pass judgement on it. He brought up something that wasn't even in the final version, I'd say it's not too much to ask for them to know these things.
#4,807  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Ditto
priest81 Non Sequitur
In reply to Chi_Mangetsu, #4788:
In reply to priest81, #4786:

Does triage really need to be euphemized? With a word that's longer, more syllables and just sounds an overly positivist kindergarten school?

Because that is what it is referred to in the industry. They call it Tri-Care
#4,808  Posted 3 years ago  |  Reply  |  Quote
In reply to priest81, #4808:

Could you or Chi clarify what you're talking about here?
#4,809  Posted 3 years ago  |  Reply  |  Quote
priest81 Non Sequitur
In reply to Izzi, #4809:

Someone was citing the insurance that our Military has. The insurance program is called Tricare.
#4,810  Posted 3 years ago  |  Reply  |  Quote
Chi_Mangetsu EmEffin TRex
In reply to Izzi, #4809:

I thought it was still CHAMPUS and most of my family in the military just call it MHS so I misunderstood him before.
#4,811  Posted 3 years ago  |  Reply  |  Quote
In reply to priest81, #4810:

In reply to Chi_Mangetsu, #4811:

That's what I thought. I'm familiar with TRICARE (used to have it) so when I saw there seemed to be some argument over the name, I wasn't sure if that's really what was being talked about and it make me more confused.
#4,812  Posted 3 years ago  |  Reply  |  Quote
In reply to Mongopwn, #4806:

Just to be clear, he does have a good point.

The argument here was severability. That is, if the court decides that the mandate is unconstitutional, can they separate it from the rest of the bill and let everything else stand? If not, do they have to throw out the entire bill (including the very positive parts that are already in force)? And if not either of those extremes, how do they determine what parts can be kept and which need to be thrown out?

They really don't need to read the whole bill to determine the major questions before them. Except that the severability question is really hard if you don't take one of the extreme options, neither of which makes much sense. There are lots of provisions entirely unrelated to the mandate and at the same time a fair few that could well be dependent on it (or at least harmful if it's eliminated). Ideally if it were struck down Congress would revise the remaining bill to patch it to work again without the unconstitutional bits, but what are the odds of that (or of the court trusting them to do that)?

It's been fairly amusing watching the debate, if from a slight distance. After Monday's arguments about the mandate people were pretty convinced it was being struck down. Then the severability argument started. And, well...
The Supreme Court spent 91 minutes Wednesday operating on the assumption that it would strike down the key feature of the new health care law, but may have convinced itself in the end not to do that because of just how hard it would be to decide what to do after that. A common reaction, across the bench, was that the Justices themselves did not want the onerous task of going through the remainder of the entire 2,700 pages of the law and deciding what to keep and what to throw out, and most seemed to think that should be left to Congress. They could not come together, however, on just what task they would send across the street for the lawmakers to perform. The net effect may well have shored up support for the individual insurance mandate itself.
#4,813  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Cool
In reply to pal_sch, #4813:

It's funny how many things become amusing when viewed from enough of a distance. If it weren't for the lingering knowledge that somewhere out there, there are people who are affected by this sort of thing in real terms, American politics would be a laugh riot.
#4,814  Posted 3 years ago  |  Reply  |  Quote
In reply to ChaosAD, #4790:

Well, we could just... you know... NOT woefully underfund it. That might work.

Of course, it's not the advocates the singlepayer system who want to underfund fund government programs, it's the ones who oppose them. And then they like to scream about how woefully underfunded these programs are how we should cut their costs. Funny how that works.

Post edited 3/29/12 3:20PM
#4,815  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Ditto
In reply to PeppyHare66, #4815:

They're underfunded, so they don't work. Obviously we need to cut the funding of programs that don't work. Logic!
#4,816  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Ditto
I think this is the best summary and prediction post regarding the SCOTUS case.

I agree with a lot of it, but... well, may as well make a fool of myself.

There are four questions here. I'll summarise them here because I don't think they have been entirely outlined before.

1) Anti-Injunction Act
This is an old (old) law that states you can't sue over a tax hasn't been collected yet. If it is held that this applies to the mandate fine then it wouldn't be possible to start suing over the law until 2015.

I'd note that neither the government nor states are claiming that his law applies. Instead this was the justification used for dismissing the case by one Circuit Judge called Brett Kavanaugh. Kavanaugh is a bit of a conservative star from the Bush and Clinton days (when he was a principle author on the Starr report) and has been tipped by a few people as a potential Supreme Court justice under any new Republican president. This could have been a strong motivation to both avoid striking down the mandate (making him harder to appoint through a polarised Senate that would likely still be dealing with healthcare fallout) and punt on the question, hoping for a Republican president and seat to open up for him when it came time to hear the real questions.

The Court appointed a lawyer to argue this position. I can't say I'd want that job.

The odds of this being used to dismiss the case are slim to none.

2) Individual mandate.
The meat.

This is somewhat tricky ground, constitutionally, because it's trying to find what limits the Commerce Clause actually has.

The popular conservative option here has been to point to how broad the mandate looks. If the government can compel people to buy insurance, doesn't that let them compel people to do any other thing that might be assessed as good for them? And, frankly, this isn't without merit. If the commerce clause allows a health insurance mandate it could easily be taken to allow all sorts of other mandates and regulations of that sort.

That probably won't appeal to the court all that much, even the more liberal judges, but at the same time it's entirely possible to draw a limit that allows such a mandate in the (effectively) unique situation of health insurance while closing the door on other mandates in the future.

The post I linked to makes two legal points in this area that suggest the mandate might be upheld. The first is that the most significant judge for this case - Kennedy - has explicitly recognised that this area must be a question of degree rather than bright lines. This suggests he could make (or be on board with) an argument that a health insurance mandate is an exception because of the unique nature of that market. The second is that there are a number of alternative methods the government could have used that are acknowledged as legal (a direct tax rather than penalty, a mandate on purchasing insurance before receiving care) but that this method was selected as the most practical. Requiring that the same thing be done in a less effective manner is probably not a winning argument in most areas.

For myself I'm not sure. The link gives this as 60:40 that the law will be upheld. I'd maybe go with a coin flip, counting in the other sources I've read. The arguments here are pretty convincing, but they haven't been picked up that widely and I'm worried about reading too much in to certain remarks or Kennedy's desire for a legacy.

3) Severability.
Went over this a bit above, so will just touch on it.

This is broadly how much of the rest of the law has to be eliminated alongside the mandate. I don't think that either the everything or the nothing positions will hold up. Even the government here pointed to two major provisions that would have to be removed if the mandate was. At a guess, a fair amount of the bill would be left standing, but how they could find a line to draw here I don't know.

4) Medicaid expansion
This is the argument that the expansion of the Medicaid program under the ACA violated states' rights. At first blush I can't really see how this can be more or less constitutional than Medicaid itself.

The main argument is that by putting extra conditions on funds given to states for Medicaid, the federal government is limiting states' rights. The federal government (so it is claimed) couldn't directly tell states how to run these programs. However, by requiring them to meet certain conditions to receive federal funding they are effectively coerced into complying with federal standards.

My main problem with this (other than a flat rejection of it) is that it would be extremely hard for the federal government to run any joint programs with states without the power to regulate how states spend that money. By claiming that adding restrictions to funds is unconstitutional coercion, I don't really see what options are available. The very act of congress passing a funding bill granting money to a state is itself conditional on any number of things. There is always going to be coercion of the states so long as they receive any federal funds.

So it must be a question (again) of degree rather than a bright line. And here we have the problem that no-one seems to be offering a clear line. The states' lawyer admitted that drawing such a line is 'hard', and didn't offer suggestions, instead saying that they should claim the Medicaid expansion as a beachhead and push back from there.

I have no idea what the law here is going to look like after this case, but I don't see them striking down the Medicaid expansion. It seems far too close to eliminating a wide swath of federal/state joint projects that aren't easily distinguished.
#4,817  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Cool
In reply to pal_sch, #4817:

Another relevant angle.

This argument hasn't been getting much play because right now the whole push is that absurd situations that are undesirable must also be unconstitutional. So broccoli mandates must be unconstitutional while leaving healthcare as legal. But this analogy makes perfect sense to me;
The most important limit, the one we fought the Revolutionary War for, is that the people doing this to you are the people you elect. Thats the main check. The broccoli argument is like something they said when we were debating the income tax: If they can tax me, they can tax me at 100 percent! And yes, they can. But they wont. Because you could vote them out of office. They have the power to do all sorts of ridiculous things that they wont do because youd vote them out of office. If they can prevent me from growing pot, can they prevent me from buying broccoli? Perhaps, but why would they if they want to be reelected? So if you ask me what the limits are, Id say read McCulloch vs. Maryland. And reread it. And keep reading it till you understand it. The Constitution is a practical document,. its designed to work. And the powers are designed to be flexible in order to achieve the aims of the document.
#4,818  Posted 3 years ago  |  Reply  |  Quote
And I really need to buy sponsorship so I can edit, but now I see this.
Hewitt: Yesterday, the presidents campaign manager said that you are the godfather of Obamacare ... if thats who you are, can you make the Democrats an offer they cant refuse to repeal it?

Romney: (laughing) Thats a great idea. We counted, by the way, that Mr. Plouffe is the Rumpelstiltskin of trying to turn straw into gold. He will not be successful. I can tell you one thing. If Im the godfather of this thing, then it gives me the right to kill it.
#4,819  Posted 3 years ago  |  Reply  |  Quote
DiMono Site Admin
In reply to pal_sch, #4819: Mitt Romney thinks godfathers have the right to kill their godchildren?
#4,820  Posted 3 years ago  |  Reply  |  Quote
Chi_Mangetsu EmEffin TRex
France best, U.S. worst in preventable death ranking
Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study. "I wouldn't say it (the last-place ranking) is a condemnation, because I think health care in the U.S. is pretty good if you have access. But if you don't, I think that's the main problem, isn't it?" Nolte said in a telephone interview.
#4,821  Posted 3 years ago  |  Reply  |  Quote  |  + 3 Ditto
In reply to Chi_Mangetsu, #4821:

Not surprised, even those of us with health insurance aren't great at maintaining regular visists and getting the appropriate screenings. That's been a big problem in the US for a while. The lack of access is, of course, the other big factor like they pointed out.
#4,822  Posted 3 years ago  |  Reply  |  Quote
Health care in America focuses on corrective treatment rather than preventive. It's our mindset that needs to be changed.

As for universal healthcare, I am for it. We are the only modern, western country that doesn't have any type of system. Also, "obamacare" isn't truly universal healthcare.

However, it doesn't really matter.... it's going to be decided by the supreme court, so unless a supreme court justice is happens to be a RT fan, it's not worth debating. Before it was passed, you could at least write your reps, but now its going to be decided by 9 people if the law stands or not. There are 5 conservatives on the court and 4 liberals, however one of the conservative justices, Anthony Kennedy, has been known to rule liberal, so this will be an interesting case.

As of now, I think the court will take out the individual mandate (citizens are compelled to get health insurance or pay a fine, every year), but leave some of the good parts alone, like preexisting conditions.
#4,823  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Ditto
In reply to Dienamik, #4823:

Haha, yeah, "Obamacare" isn't anywhere near universal healthcare. It's just some people making mountains out of molehills and claiming that's where it's taking us.
However, it doesn't really matter.... it's going to be decided by the supreme court, so unless a supreme court justice is happens to be a RT fan, it's not worth debating.
Why is it not worth debating? That's kind of the whole purpose of these forums.
#4,824  Posted 3 years ago  |  Reply  |  Quote
Quarters Arpeggiator
In reply to Dienamik, #4823:

What I'm worried most about is what happens to the rest of the bill if the individual mandate is struck down. The mandate is what makes the other provisions people like (no pre-existing conditions, 80% of intake spent on healthcare) possible since there will be a far larger and overall healthier risk pool to draw from. Without that, the whole thing becomes financially untenable without insurers jacking up prices a dramatic amount.
#4,825  Posted 3 years ago  |  Reply  |  Quote  |  + 1 Ditto
Quarters Arpeggiator
In reply to Quarters, #4825:

Which, I should add, would be doubly annoying because then Republicans and the right-wing hate machine would simply jump up and down screaming "SEE? OBAMACARE JUST MAKES THINGS WORSE" when they were the ones blasting holes in the ship to make it sink.
#4,826  Posted 3 years ago  |  Reply  |  Quote
DiMono Site Admin
In reply to Quarters, #4826:
#4,827  Posted 3 years ago  |  Reply  |  Quote
KWierso Sponsor
#4,828  Posted 3 years ago  |  Reply  |  Quote
KWierso Sponsor
The Onion loses to reality at 1:37. There is no recovery.
#4,829  Posted 3 years ago  |  Reply  |  Quote
In reply to KWierso, #4829:

That woman beside him laughing is obnoxious. Plus their sign just shows how incredibly misinformed they are.
#4,830  Posted 3 years ago  |  Reply  |  Quote
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