OBAMA/TRUMPCARE MEGATHREAD

[Y2HH]

Strangesox,

 

Correct me if im wrong, but isnt the pre-existing condition part entirely unrelated to the mandate part?

 

I believe that the law about pre-existing conditions would be enforceable but for the mandate.

 

Furthermore, couldnt the govt/insurance companies provide some sort of cheaper insurance (like liability insurance for cars), that would at least provide minimum levels of coverage. Or couldnt the govt give insurance and count it as a benefit, such as food stamps, etc.

 

The mandate exists mainly to cover the pre-existing clause.

[Soxbadger]

That is just silly (for congress to set it up that way).

 

There is no question (at least in my mind) that the govt couldnt draft a law stating that insurance companies can not deny coverage due to pre-existing conditions. I believe that would fully be within their power.

Edited March 30, 2012 by Soxbadger

[farmteam]

But it's not the Court's role to determine policy for the country. It's their job to interpret the law and decide its constitutionality. This is a legislative problem, not a judicial one.

 

I'm really tempted to start a departmentalism debate in the Buster, that would go over well....

[StrangeSox]

Strangesox,

 

Correct me if im wrong, but isnt the pre-existing condition part entirely unrelated to the mandate part?

 

I believe that the law about pre-existing conditions would be enforceable but for the mandate.

 

Furthermore, couldnt the govt/insurance companies provide some sort of cheaper insurance (like liability insurance for cars), that would at least provide minimum levels of coverage. Or couldnt the govt give insurance and count it as a benefit, such as food stamps, etc.

 

The mandate is necessary in order for insurance companies not to implode under a litany of pre-existing condition applicants that they're now required to take on. If they have to cover patients with pre-existing conditions (without exorbitant rates) but there is no mandate, I can simply wait on buying insurance until I have cancer, then get a policy at the same price as everyone else and stick the insurer with the hundreds of thousands of dollars of costs.

 

The government already provides Medicare and Medicaid. I'm all for expanding those programs to everyone.

[StrangeSox]

That is just silly (for congress to set it up that way).

 

There is no question (at least in my mind) that the govt couldnt draft a law stating that insurance companies can not deny coverage due to pre-existing conditions. I believe that would fully be within their power.

 

It's absolutely within their power, and it would also likely bankrupt them. That's why we'll be in for interesting times if the mandate is struck down but the rest of the act is left in place.

 

It's also why the argument for the mandate comes in under N&P, since it is necessary for legitimate, constitutional regulation like the Guaranteed Issue provision.

[Jenksismyhero]

So you change the law.

 

You cant just box yourself into an untenable position and do nothing about it.

The fact is, the US can not continue down this path. You cant continue giving health care for everyone and having a few pay for it. It just wont work, so something has to be done, and I personally dont think we should change the law to prevent people from getting treatment, but maybe that is what have to gives.

 

Because you just cant have it where people are guaranteed treatment and the govt/tax payers end up paying the bills. This just cant last forever.

 

Coverage is only part of the problem, which is why this bill sucked and didn't really address much despite the price tag. Costs are out of control and that has little to do with covering the costs of uninsureds. A private practice that doesn't tailor to anyone but those with insurance still charge an assload for care that's simply not comparative to the price. They do that because they can. I don't want the government stepping in and putting up a list of costs that doctors/hospitals have to follow, but there's got to be some price control measures that can be put in place.

 

[Y2HH]

That is just silly (for congress to set it up that way).

 

There is no question (at least in my mind) that the govt couldnt draft a law stating that insurance companies can not deny coverage due to pre-existing conditions. I believe that would fully be within their power.

 

The reason why that doesn't work is because nobody would be paying into insurance until they needed it...BECAUSE you cannot be denied for pre-existing conditions.

 

Therefore...why bother paying for something that cannot be denied to you when you suddenly need it?

 

Entire system collapses.

 

That would be akin to waiting until you get into a car accident, then calling State Farm for insurance to cover the accident you just had...knowing they cannot deny your "pre-existing" car wreck, and would have to pay out on it. It's fairly simple to see why it wouldn't work.

[StrangeSox]

They COULD, but it would have been pricey.

 

It would either be so costly as to effectively be unavailable or simply unavailable.

[StrangeSox]

But it's not the Court's role to determine policy for the country. It's their job to interpret the law and decide its constitutionality. This is a legislative problem, not a judicial one.

 

You can't defend Scalia's oral arguments and then say it's not for the Court to determine policy.

[Soxbadger]

If they have to cover patients with pre-existing conditions (without exorbitant rates) but there is no mandate, I can simply wait on buying insurance until I have cancer, then get a policy at the same price as everyone else and stick the insurer with the hundreds of thousands of dollars of costs.

 

But you could easily change the law, to state that everyone in the US has a ____ enrollment period when the law enacts, to get the great rate. After that period the rates go up.

 

It just seems that there are answers to these questions that are practical. I dont understand why we have to keep forcing a square peg into a round space.

[Jenksismyhero]

You can't defend Scalia's oral arguments and then say it's not for the Court to determine policy.

 

I don't think I was really defending them more than attempting to explain the method.

 

[Y2HH]

But you could easily change the law, to state that everyone in the US has a ____ enrollment period when the law enacts, to get the great rate. After that period the rates go up.

 

It just seems that there are answers to these questions that are practical. I dont understand why we have to keep forcing a square peg into a round space.

 

You could...but Congress isn't all that smart, now is it?

[StrangeSox]

But you could easily change the law, to state that everyone in the US has a ____ enrollment period when the law enacts, to get the great rate. After that period the rates go up.

 

It just seems that there are answers to these questions that are practical. I dont understand why we have to keep forcing a square peg into a round space.

 

The problem is that people's insurance is often tied to their job, which is a s***ty system in and of itself. So if they have insurance now but lose their job in 5 years, have a gap in insurance coverage and then develop cancer, they're f***ed. Insurance status and medical status change frequently for people, so an initial enrollment period doesn't help them, especially people who aren't even born yet.

 

The round space is a boondoggle private insurance market.

Edited March 30, 2012 by StrangeSox

[StrangeSox]

Some blogging over at the Incidental Economist (health policy/economics blog) has some recommended reading on the distinction between insurance pools and other goods/services that several of the justices and the SG seemed to miss:

 

http://theincidentaleconomist.com/wordpres...dy-should-read/

 

http://theincidentaleconomist.com/wordpres...-oral-argument/

 

I think this is an important bit:

 

* This is quite distinct from the free rider argument when uninsured people seek uncompensated care (see the Health Care For All brief); the health insurance impact is automatic and actuarial, whether or not the uninsured person ever seeks care.

[Soxbadger]

Strange Sox,

 

Once again, that issue can be resolved. The law could easily state that if your insurance is tied to your employer, that when you are terminated you can still continue to get the same coverage for the same price.

 

I guess I just dont understand why there cant be some sort of compromise, this literally seems like an issue that reasonable people can figure out.

 

I assume that most people want reasonably priced health insurance, I assume that most people do not want their tax payer money going to other peoples medical bills.

 

Based on those 2 assumptions, you would think that there could be some sort of compromise for the better of the United States.

 

That is the problem that I have with this, that everyone would benefit if we can just come up with an agreement.

 

Instead of digging in on the issues, people should be thinking about ways to make it work for everyone. This isnt gun control or abortion, where there is simply no way to rectify or compromise, this is an issue where seemingly everyone is losing, yet no one wants to be the one who says, "Okay, lets give in a little, lets figure this out."

[StrangeSox]

You didn't resolve the second issue, one of somebody who currently has no insurance because they're not actually born yet. The solution you came up with above is a one-time shot.

 

The mandate is meant to solve a free-rider problem as well as an actuarial problem since health insurance can no longer be underwritten. Providing a whole mess of exemptions that still allows insurance to be underwritten seems like a much more difficult, complex and ultimately flawed solution than what the mandate does.

 

This also isn't an issue of taxpayer dollars necessarily. This is about the actuarial models of private insurers.

 

I don't think it's fair to say no one is willing to compromise. The PPACA had single-payer stripped out rather quickly, and a fully socialized health care system was never on the table. The end form of PPACA is nearly identical to the Republican Massachusetts plan which was largely patterned on the conservative Heritage Foundation plan from the 90's. In addition to that, while the mantra has been "Repeal and Replace," the actual details of "Replace" have been non-existent. One side simply does not see this as a priority or something that government can or should fix.

[Soxbadger]

You didn't resolve the second issue, one of somebody who currently has no insurance because they're not actually born yet. The solution you came up with above is a one-time shot.

 

No it isnt.

 

The rule could for unborns or for non-adults, that you have 2 years after you turn 18, or 2 years after you complete college, or whatever period you want.

 

This gives everyone the chance to buy insurance.

[StrangeSox]

No it isnt.

 

The rule could for unborns or for non-adults, that you have 2 years after you turn 18, or 2 years after you complete college, or whatever period you want.

 

This gives everyone the chance to buy insurance.

 

but ultimately, insurers would still be free to turn down people with pre-existing conditions. If you couldn't afford insurance at 18, got cancer at 24 and beat it, you could still face a future with limited or no health insurance options.

[Balta1701]

Strange Sox,

 

Once again, that issue can be resolved. The law could easily state that if your insurance is tied to your employer, that when you are terminated you can still continue to get the same coverage for the same price.

The law actually said this for a long time, it was called the "COBRA" plan. However, the biggest problem is that unemployed people generally cannot afford $20,000 on average for a family of 4, and when the employer contribution, which is 90% of that, goes away, that's it.

 

Edit: Also, the insurers had to be forced to do that by the government for a reason, because it had the same catch-22. If people were generally healthy, they wouldn't pay that kind of money on their own. If people had a sick kid, and they lost their job, they'd do whatever they could to hold onto that insurance.

[Soxbadger]

But nonetheless, there are ways to draft the law to prevent those situations and be fair to all americans.

 

The problem is that when its all or nothing, the likely outcome is nothing. Its better to give in and get the majority of what you want, then to get nothing.

 

Also, and this in my opinion is important, because once people begin to become more comfortable with the idea, it will be easier to create other laws that may be more encompassing. But generally the first laws on an area are much narrower.

Edited March 30, 2012 by Soxbadger

[Balta1701]

But nonetheless, there are ways to draft the law to prevent those situations and be fair to all americans.

 

The problem is that when its all or nothing, the likely outcome is nothing. Its better to give in and get the majority of what you want, then to get nothing.

 

Also, and this in my opinion is important, because once people begin to become more comfortable with the idea, it will be easier to create other laws that may be more encompassing. But generally the first laws on an area are much narrower.

If you can't reform the health insurance industry at this level, then you literally cannot do anything at the national level.

[Soxbadger]

I believe you can reform the health care industry, but I believe that this law may have gone to far to start.

 

In general, American jurisprudence moves slowly. It took 100 years from the Civil War to the Civil Rights movement. But during those 100 years, laws were passed that slowly gave more rights.

 

Thats where I think this law may have gone off the tracks, that they went for to much to quickly. That is why I wonder if a better approach would have been through the privilege route.

 

At the end of the day, it doesnt matter how you get there, it just matters you get to where you want to go.

[StrangeSox]

I believe you can reform the health care industry, but I believe that this law may have gone to far to start.

 

In general, American jurisprudence moves slowly. It took 100 years from the Civil War to the Civil Rights movement. But during those 100 years, laws were passed that slowly gave more rights.

 

Thats where I think this law may have gone off the tracks, that they went for to much to quickly. That is why I wonder if a better approach would have been through the privilege route.

 

At the end of the day, it doesnt matter how you get there, it just matters you get to where you want to go.

 

If they called it a tax instead of a penalty with the exact same mechanisms and regulations otherwise, it wouldn't be in court.

[Soxbadger]

Once again, back to my point, why not draft it in a way that there is the least path of resistance?

[Balta1701]

Once again, back to my point, why not draft it in a way that there is the least path of resistance?

This. Was.

 

Everything and the farm was given up. And I mean everything. The original House version of the Bill was a better bill by a factor of 100. But the Senate wanted to hit arbitrary spending goals, make Ben Nelson and Joe Lieberman happy, and let that terrible budget committee process go forward.

 

The reason that the mandate text doesn't use the word "Tax" is that one of those guys, and we don't know who but probably one of those two, wouldn't vote for it if that word appeared in the structure of it. The Senate is that petty.

 

My personal favorite moment of the whole debate was when Joe Lieberman though he'd do something great and centrist and totally undercut the bill by offering to get rid of the whole thing and just expand medicare eligibility down to 55. After all, that'd still leave people uninsured, so it'd have to be a centrist bill...And then the liberals loved it, so he immediately dropped his own proposal and disavowed it.