American Health Care Reform

[Dr. McCoy]

So many progressives are pissed off at Obama for the debt ceiling deal right now, but I heard some good news. They say this is the first time in like 50 years where health care costs didn't go up. I couldn't confirm whether or not it was true, but I'll put up a link if I can find it.

Edit: http://www.thepeoplesview.net/2011/07/b ... ds-to.html

[in 2010, National Health Expenditure] grew by 3.9%. That's 17% lower than estimated. As you will notice, the GDP growth rate was almost the same as was estimated (4.0% estimated vs. 3.8% actual). This match is unprecedented in at least 50 years.

This is from a new progressive blog. There's a link to a government PDF. It looks real complicated.

[Gao Bohan]

The U.S. Court of Appeals for the 11th Circuit has ruled the purchase mandate unconstitutional. From the Wall Street Journal.

A divided U.S. appeals court in Atlanta ruled Friday that a key provision of last year's federal health-care overhaul is unconstitutional, siding with a group of 26 states that challenged the law.

The 2-1 ruling marks the Obama administration's biggest defeat to date in the multifront legal battle over the health-care law.

The U.S. Court of Appeals for the 11th Circuit ruled that Congress exceeded its constitutional powers when it required individuals to purchase health insurance or pay a penalty.

"This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives," Judges Joel Dubina and Frank Hull said in a jointly written 207-page opinion.

Judge Dubina is a George H.W. Bush appointee, while Judge Hull was appointed by Bill Clinton.

The decision directly conflicts with a different ruling issued in June by a federal appeals court in Cincinnati that upheld the law. The disagreement between the circuits makes it a near certainty that the Supreme Court will eventually step in and provide the final word on the law's constitutionality.

Several legal challenges are working their way through the nation's courts, but Friday's ruling came in the highest-profile lawsuit of them all: a case brought by 26 governors and attorneys general, from states including Florida, Ohio and Texas.

The decision affirmed part of a January ruling by U.S. District Judge Roger Vinson of Florida, who ruled the health-insurance mandate unconstitutional.

The appeals court, however, overturned the portion of Judge Vinson's decision that voided the entire health-care law. The court said the unconstitutional insurance mandate could be severed from the rest of the law, with other provisions remaining "legally operative."

In dissent, Judge Stanley Marcus, a Clinton appointee, said the majority ignored Congress's broad power to regulate commerce. The insurance mandate, he said, was a rational and permissible attempt to address the huge health-care costs that uninsured Americans impose on others.

The Cincinnati-based Sixth Circuit Court of Appeals upheld the health law on a 2-1 vote in June. The challengers in that case, four individuals and the Thomas More Law Center, a conservative legal organization, have already appealed that ruling to the Supreme Court. The high court is on summer break. Its new term begins in October and runs through June 2012.

A third appeals-court ruling on the constitutionality of the health law is expected soon from the Fourth Circuit in Richmond, Va. At issue in that case are two challenges, including one brought by Virginia Republican Attorney General Ken Cuccinelli.

I don't understand the court's position. I get why they think the purchase mandate is unconstitutional, but no substantive part of the ACA is "legally operative" without it. To make it clear, if the SCOTUS upholds their decision as is, then insurance companies will still be required to provide coverage to everybody, even though people can just wait until they get sick to buy it. Both sides have repeatedly stated that the ACA is not viable without the purchase mandate. Insurance premiums would skyrocket, and eventually the public would demand a full on repeal of the law. That would of course suit the interest of the Republican Party.

[CraigTPE]

Both sides have repeatedly stated that the ACA is not viable without the purchase mandate. Insurance premiums would skyrocket, and eventually the public would demand a full on repeal of the law. That would of course suit the interest of the Republican Party.

Oooooorrrrrrrrrrrrr, the public would demand national health care. Health care is a basic human need, not a luxury like a TV. People get sick. But, it's getting so people can't afford a doctor. THIS is what is unacceptable.

And, it may suit the Republican party of today, but it certainly doesn't suit the Republican party of yesterday, who CAME UP WITH THE IDEA IN THE FIRST PLACE. Who knows what the Republican party of tomorrow will want.

[Gao Bohan]

Oooooorrrrrrrrrrrrr, the public would demand national health care.

Not likely. The public was fairly disgusted with the wheeling and dealing that when on in the Senate, and they were soured on health care reform (remember that the more liberal House bill had popular support of 63%). The constant attack ads against the law are not helping either. If the SCOTUS overturns the purchase mandate, which I think is likely, or Obama loses and the law is repealed, I think it will be 40-50 years before another serious attempt at reform is made.

And, it may suit the Republican party of today, but it certainly doesn't suit the Republican party of yesterday, who CAME UP WITH THE IDEA IN THE FIRST PLACE. Who knows what the Republican party of tomorrow will want.

Yeah, I covered that back on page 13. On the slim chance that the SCOTUS doesn't savage the law before the election, Obama could use that to his advantage. Given that the Republican plan of 1993-94 is now law, what do they have left? Nothing, effectively. Obama might be able to use that, but I doubt that also. Actually, I think the law is destined for the scrapheap of history, and soon we'll be back where we started.

[Gao Bohan]

The U.S. Court of Appeals for the District of Columbia has upheld the Affordable Care Act. Note that the judge writing the opinion is a Reagan appointee. From HuffPo:

WASHINGTON — A conservative-leaning panel of federal appellate judges on Tuesday upheld President Barack Obama's health care law as constitutional, helping set up a Supreme Court fight.

A panel of the U.S. Court of Appeals for the District of Columbia issued a split opinion upholding the lower court's ruling that found Congress did not overstep its authority in requiring people to buy health insurance or pay a penalty on their taxes, beginning in 2014. The requirement is the most controversial requirement of Obama's signature domestic legislative achievement and the focus of conflicting opinions from judges across the country. The Supreme Court is expected to decide soon, perhaps within days, whether to accept appeals from some of those earlier rulings.

The suit in Washington was brought by the American Center for Law and Justice, a legal group founded by evangelist Pat Robertson. It claimed that the insurance mandate is unconstitutional because it forces Americans to buy a product for the rest of their lives and that it violates the religious freedom of those who choose not to have insurance because they rely on God to protect them from harm. But the court ruled that Congress had the power to pass the requirement to ensure that all Americans can have health care coverage, even if it infringes on individual liberty.

"The right to be free from federal regulation is not absolute and yields to the imperative that Congress be free to forge national solutions to national problems," Judge Laurence Silberman, an appointee of President Ronald Reagan wrote in the court's opinion. Silberman was joined by Judge Harry Edwards, a Carter appointee.

Judge Brett Kavanaugh, a former top aide to President George W. Bush who appointed him to the bench, disagreed with the conclusion without taking a position on the merits of the law. He wrote a lengthy opinion arguing the court doesn't have jurisdiction to review the health care mandate until after it takes effect in 2014.

The federal appeals court in Cincinnati also upheld the law. The federal appeals court in Atlanta struck down the core requirement that Americans buy health insurance or pay a penalty, while upholding the rest of the law.

And like Kavanaugh's dissenting opinion, an appeals court in Richmond, Va., ruled it was premature to decide the law's constitutionality.

[Gao Bohan]

The US Supreme Court will hear the case in March, with a ruling expected by late June. From CNN:

The Supreme Court has carved out a week in late March to hold oral arguments in perhaps its biggest case in a decade -- the sweeping healthcare reform law championed by President Obama.

The court announced Monday it will hear 5½ hours of arguments spread over three days March 26-28.

The Patient Protection and Affordable Care Act (PPACA or ACA) was signed into law March 23, 2010, passed by a Democratic congressional majority with the support of the president. It has about 2700 pages and contains 450 some provisions.

A ruling from the court is expected by late June and regardless of the outcome, will become a major issue in a presidential election year.

[Gao Bohan]

The Supreme Court case has begun. It looks like the court is headed towards a 5-4 decision against the law. So much for national health care in the US.

[Mick]

Wouldn't it have benefited more if Obama had tried to create a cheap alternative such as scrapping IP laws for common drugs like insulin and then producing them dirt cheap (as an example) slowly building up government hospitals rather than throwing trillions at the private health care institutions and feeding the already very wealthy pharmaceutical companies and insurance companies?

We have always had free health care in the UK, but they are not 5 star accommodations, I think they do very well, they think all the time how to keep costs down, we also have private health care, for those who want it, I suppose the food is better, might not have to share a room and so on. But you couldn't get everyone in the UK to go private, it just would cost too much.

But thats seems to be what the American health care reform is, the US has never had anything except private, if everyone is to get health care, they need to all use the private health care hospitals and they don't come cheap. Seems to me if the goal is universal health care that doesn't bankrupt the nation (companies and individuals too on insurance perhaps) , you need to drastically change the system.

[Gao Bohan]

Wouldn't it have benefited more if Obama had tried to create a cheap alternative such as scrapping IP laws for common drugs like insulin and then producing them dirt cheap (as an example) slowly building up government hospitals rather than throwing trillions at the private health care institutions and feeding the already very wealthy pharmaceutical companies and insurance companies?

We have always had free health care in the UK, but they are not 5 star accommodations, I think they do very well, they think all the time how to keep costs down, we also have private health care, for those who want it, I suppose the food is better, might not have to share a room and so on. But you couldn't get everyone in the UK to go private, it just would cost too much.

But thats seems to be what the American health care reform is, the US has never had anything except private, if everyone is to get health care, they need to all use the private health care hospitals and they don't come cheap. Seems to me if the goal is universal health care that doesn't bankrupt the nation (companies and individuals too on insurance perhaps) , you need to drastically change the system.

Free public clinics and charity hospitals already dot the landscape, but they are generally overwhelmed and underfunded, with a proportional capacity far lower than Britain's NHS. The purpose of the Affordable Care Act was to broaden coverage and lower costs without gutting the existing health care infrastructure, which is in fact a mix of public and private contigencies. The Netherlands and Switzerland took similar paths in 1948-1949, as they too had robust private systems but wanted to provide univeral health care. The Massachusetts health care system, known as MassCare and ironically signed into law by Republican Presidential Candidate Mitt Romney (who now rabidly opposes univeral health care), was loosely based on the Dutch and Swiss systems. It's worth noting that those countries have successfully managed their health care systems, which remain largely private and include individual mandates to purchase health insurance, for the past 60 years. Massachusetts has faired well since it passed MassCare in 2006.

Despite the rhetoric one hears from Republicans, most Americans don't enjoy 5 star accomodations either. The quality of health care in the US is generally comparable to other Western nations, but with a far higher price tag, both overall and more importantly, per capita. The reason for this is two-fold: 1. Millions of healthy Americans choose not to purchase health insurance, resulting in higher premiums for those that do, and 2. Millions of unhealthy Americans can't afford regular health care, and are only treated when their conditions become emergencies. 60% of bankruptcies in the US are primarily caused by unexpected medical costs. But even with people pouring out all their savings, uninsured people still incur some US$40 billion in medical bills they cannot pay, resulting in hospitals eating these costs. They pass off as much of these costs to the insured and the federal government they possibly can. Our health care system is, in a word, inefficient.

The ACA would have mitigated these problems to a great extent, simply by compelling all citizens and legal residents to purchase health insurance. The flip side of the coin would be that health insurance companies must guarantee issue, and the federal government would subsidize the poor so they too can be covered. The net result would be more coverage and lower costs, at least in theory. The experience of the Netherlands and Switzerland leads to me believe that theory would be reality.

But none of that matters if the five Republican justices on the Supreme Court toss out the law, as even supporters now believe they will. The five Republican justices asked very pointed, leading questions which strongly indicate they will strike down the law. Note that while the individual mandate and guaranteed issue provisions were not scheduled to be implemented until 2014 for adults, the law immediately lifted lifetime caps, required guaranteed issue for children, and created subsidized high risk insurance for adults. Estimates vary, but somewhere between 40,000-100,000 people currently rely on the ACA for coverage. The nearly inevitable Republican victory in court may lead, quite literally, to thousands of children and adults dying from lack of regular medical care.

[fh2000]

The reason I found this website and check on it regularly is because of heath care, or lack of it if I early retire in US. We all know our health care is tied to our jobs. No jobs, no health care. No health care, no early retirement. We will have to work until 65.

So I came back to Taiwan last summer and got my Hukou back and started to pay into NHI. This will be our safety net and looks like we will have to rely on this for sure if and when US health reform is repealed.