Health Care Law Massacred in Supreme Court

[jrobie79]

http://www.businessinsider.com/people-are-saying-that-obamas-healthcare-law-got-massacred-in-the-supreme-court-today-2012-3

The Supreme Court just wrapped up the second day of oral arguments in the landmark case against President Obama's healthcare overhaul, and reports from inside the courtroom indicate that the controversial law took quite a beating.
Today's arguments focused around the central constitutional question of whether Congress has the power to force Americans to either pay for health insurance or pay a penalty.
According to CNN's legal analyst Jeffrey Toobin, the arguments were "a train wreck for the Obama administration."
"This law looks like it's going to be struck down. I'm telling you, all of the predictions including mine that the justices would not have a problem with this law were wrong," Toobin just said on CNN.
Toobin added that that the Obama administration's lawyer, U.S. Solicitor General David Verrelli, was unprepared for the attacks against the individual mandate.
"I don't know why he had a bad day," he said. "He is a good lawyer, he was a perfectly fine lawyer in the really sort of tangential argument yesterday. He was not ready for the answers for the conservative justices."
In the aftermath of today's arguments, Toobin and many other legal reporters agree that the Obamacare decision will come down to a fight between the nine Supreme Court justices.
According to reports from the courtroom, the four liberal justices seem inclined to uphold the law. But it is still unclear if the Obama administration's legal team will be able to get a fifth vote.
The WSJ reports that Justice Anthony Kennedy, who is considered the swing vote in the case, reportedly pushed Verrelli hard on his defense of the individual mandate, telling him that the government has a "very heavy burden of justification" to show where the Constitution gives Congress the power to force people to buy healthcare.



Tom Goldstein of SCOTUS blog sums up the end of the arguments:
Towards the end of the argument the most important question was Justice Kennedy’s. After pressing the government with great questions Kennedy raised the possibility that the plaintiffs were right that the mandate was a unique effort to force people into commerce to subsidize health insurance but the insurance market may be unique enough to justify that unusual treatment. But he didn’t overtly embrace that. It will be close. Very close.

[gkurey]

This is good news; this bill was garbage rammed down the throats of all Americans.

[nando]

it's too bad, the basic idea was sound. the actual law that got passed though - yikes!

[jrobie79]

"In an indication of how poorly Obama's solicitor general was at arguing in favor of the law, the liberal justices had to suggest defenses of the law on his behalf." -- Philip Klein

[rwh11385]

Good news. All the Republican candidate's talk really weren't as important as the third branch of government's opinion.

Have all those bleeding heart liberals set up foundations (similar to what Gates did for global vaccines) that provides healthcare screening and care for the less fortunate, and have private accountability keep people from abusing the system. Giving back through choice rather than taxes and government's direction is the important thing.

[nrubenstein]

Good news. All the Republican candidate's talk really weren't as important as the third branch of government's opinion.

Have all those bleeding heart liberals set up foundations (similar to what Gates did for global vaccines) that provides healthcare screening and care for the less fortunate, and have private accountability keep people from abusing the system. Giving back through choice rather than taxes and government's direction is the important thing.

While I agree that the ACA as implemented wasn't a great thing, the s imple fact of the matter is that we pay far more for worse outcomes than, well, almost anywhere else with a robust medical care system. A lot of that is because so many people either a) choose not to have coverage, or b) can't have coverage. People in category a) or b) don't not use health care. They use more expensive care because they don't get preventative care and end up in the emergency rooms when they finally can't stand it. Since they can not pay, well, who ends up footing the bill? We do. Either in ever increasing insurance rates, or in those unfuckingbelievably inflated medical bills (usually multiples of 3 or more times cost) because their collection rates are so poor.

This isn't sustainable. Period.

That said, without a public option (permitted to aggressively negotiate rates and prices) ,I'm not convinced the program as written is sustainable either.

[Ryan Stewart]

I love how totally transparent it is. Even the liberal justices are trying to argue for the case that its not unconstitutional to basically put a mandate on people to carry insurance for the privilege of living in the US. Sure, some of the other stuff can be argued but the personal mandate was complete bullshit from miles away.

[rwh11385]

That said, without a public option (permitted to aggressively negotiate rates and prices) ,I'm not convinced the program as written is sustainable either.

For the bigger chunk of your post, why is that the government's job? And how could they do it better than a NPO? (And with NPOs, you could hire up all these unemployed caring Gen Yers) I know a health promotions / communications grad who was doing screenings and consulting but now works as a restaurant server. If people do care so much about this, they should organize using their time or money to make solutions rather than expecting the government to make everything better.

I'm not gonna trust a public option ever being economical as long as Medicaid and Medicare keep ballooning out of control. We have a problem in the cost of keeping people healthy, but a massive power grab by the government isn't the solution.

[nrubenstein]

For the bigger chunk of your post, why is that the government's job? And how could they do it better than a NPO? (And with NPOs, you could hire up all these unemployed caring Gen Yers) I know a health promotions / communications grad who was doing screenings and consulting but now works as a restaurant server. If people do care so much about this, they should organize using their time or money to make solutions rather than expecting the government to make everything better.

I'm not gonna trust a public option ever being economical as long as Medicaid and Medicare keep ballooning out of control. We have a problem in the cost of keeping people healthy, but a massive power grab by the government isn't the solution.

Medicare and Medicaid are a huge problem at least in part because they are not really permitted to behave responsibly. When rates and prices can't be set independently, you already have a huge issue. When end of life care is absolutely obscenely expensive because people spend hundreds of thousands of dollars, if not millions in an absurd effort to extend their lives by a few months, something is broken. (Here is a hint - doctors are far more likely to have a DNR on file than pret much anyone else. That's how highly they think of this sort of care.)

Of course, the problem was that all of this got pilloried as Death Panels and that the government was just going to kill Grandma. Not a rational discussion of whether it's better to keep someone alive in agonizing pain for a few months at an enormous cost to society.

As for non-profits, frankly, they have neither the money nor the clout to do this effectively. And you damned well know it. As it stands, the government already mandates 100% health coverage via the emergency room.

So really, the reason why it has to be the government is that NO ONE ELSE CAN DO IT. You can argue that people who can't afford medical care should not receive any, but saying that that is the role of non-profits is little more than a sop to the conscience. It's completely and utterly unrealistic.

As for the cost control problem, well, I will confess that I just don't really know how to solve that in our current kleptocracy. The Republicans are worse about it than the Democrats, but that's really like saying first degrees murder is worse than second degree. Somebody is still dead for no good reason. I have a fair number of thoughts on how to deal with that, but I don't see a chance in hell of any of them happening.

[rwh11385]

Medicare and Medicaid are a huge problem at least in part because they are not really permitted to behave responsibly. When rates and prices can't be set independently, you already have a huge issue. When end of life care is absolutely obscenely expensive because people spend hundreds of thousands of dollars, if not millions in an absurd effort to extend their lives by a few months, something is broken. (Here is a hint - doctors are far more likely to have a DNR on file than pret much anyone else. That's how highly they think of this sort of care.)

Of course, the problem was that all of this got pilloried as Death Panels and that the government was just going to kill Grandma. Not a rational discussion of whether it's better to keep someone alive in agonizing pain for a few months at an enormous cost to society.

As for non-profits, frankly, they have neither the money nor the clout to do this effectively. And you damned well know it. As it stands, the government already mandates 100% health coverage via the emergency room.

So really, the reason why it has to be the government is that NO ONE ELSE CAN DO IT. You can argue that people who can't afford medical care should not receive any, but saying that that is the role of non-profits is little more than a sop to the conscience. It's completely and utterly unrealistic.

As for the cost control problem, well, I will confess that I just don't really know how to solve that in our current kleptocracy. The Republicans are worse about it than the Democrats, but that's really like saying first degrees murder is worse than second degree. Somebody is still dead for no good reason. I have a fair number of thoughts on how to deal with that, but I don't see a chance in hell of any of them happening.

So frankly, you believe that because the people who want to support healthcare as a right don't support such efforts with their own money, it is the government's job to take from people to pay for this?

There are plenty of celebrities who 'believe' in causes and Obama's campaign has demonstrated that many people giving a small amount can add up quickly, but still all of this compassion ends when it comes to raising money for the thing the same people feel is a moral injustice?

*Shrug* http://www.nonprofithealthcare.org/r...fitresults.asp

IMO, the only way costs can come down is the same way we bring down the costs of everything else, competition or innovation. I see health care providers more able to find efficiency than public oversight of them... and people can support "socially responsible" companies, or help fund groups that sponsor preventative care.

[z31maniac]

We have a problem in the cost of keeping people healthy

A lot of that is down to how unhealthy America is.

2/3 overweight or obese, 1/6 on cholesterol reducing statin drugs, etc etc etc

But people refuse to take responsibility for their own actions, hey wait, that's why we are having htis debate to begin with......

[Exodus_2pt0]

2/3 overweight or obese

From what I see daily, that's really not true at all.

Oh, and the BMI's idea of "obese" is a joke.

[jrobie79]

health care costs a lot more than it used to because well....there is more healthcare out there. And RWH, don't you know the old mantra, socialism is only for the people, not the socialist

[nrubenstein]

So frankly, you believe that because the people who want to support healthcare as a right don't support such efforts with their own money, it is the government's job to take from people to pay for this?

There are plenty of celebrities who 'believe' in causes and Obama's campaign has demonstrated that many people giving a small amount can add up quickly, but still all of this compassion ends when it comes to raising money for the thing the same people feel is a moral injustice?

*Shrug* http://www.nonprofithealthcare.org/r...fitresults.asp

IMO, the only way costs can come down is the same way we bring down the costs of everything else, competition or innovation. I see health care providers more able to find efficiency than public oversight of them... and people can support "socially responsible" companies, or help fund groups that sponsor preventative care.

What I am saying is that health care in this country represents far too large a share of GDP in this country for any private group to fund a meaningful amount of it.

And frankly, what makes you think that private, for profit health care achieves greater efficiency? If you measure outcomes (i.e. hospital infections, errors, lifespan, overall health, etc.), what you find is that we are spending vastly more than anyone else for an actual outcome that is equal to or worse than what others get.

What I am saying is that right now we are paying more than we would if we had a decent single payer system and that we are achieving no more than parity. This is flat out stupid..

Personally, I would actually be OK with slashing government. We don't need to spend more than a small fraction of what we do on defense. Social security is a boondoggle. And Medicare/Medicaid are vastly more expensive than they need to be.

To reiterate: Our current medical care system is a disaster. It's hugely expensive and not that good. And the notion that small donations could add up quickly to a meaningful fraction of $2-3 TRILLION is utterly and completely laughable.

[rwh11385]

And frankly, what makes you think that private, for profit health care achieves greater efficiency? If you measure outcomes (i.e. hospital infections, errors, lifespan, overall health, etc.), what you find is that we are spending vastly more than anyone else for an actual outcome that is equal to or worse than what others get.

*Shrug* http://www.nonprofithealthcare.org/r...fitresults.asp

* Le Click *

Advocacy Posted: 11/29/2011

For the 7th Straight Year, Most Top-Quality Health Plans are Nonprofit

(...)

• 29% of the 390 Private plans reporting are nonprofit, yet:

o 100% of the Top-Ten ranked plans are nonprofit
o 100% of the Top-Twenty ranked plans are nonprofit
o 68% of the Top-25th Percentile ranked plans are nonprofit


• 31% of the 341 Medicare plans reporting are nonprofit, yet:

o 100% of the Top-Ten ranked plans are nonprofit
o 95% of the Top-Twenty ranked plans are nonprofit
o 54% of the Top-25th Percentile ranked plans are nonprofit

• 40% of the 99 Medicaid plans reporting are nonprofit, yet:

o 100% of the Top-Ten ranked plans are nonprofit
o 75% of the Top-Twenty ranked plans are nonprofit
o 76% of the Top-25th Percentile ranked plans are nonprofit

Putting power from the hands of people who care and work in an industry to the oversight of bureaucratics is a poor move.

And assuming that private = for profit is choosing your argument carefully to stack the deck in your favor.