Obama's Healthcare Reform and the Supreme Court
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But I think it points to the fact that we're fixing the wrong problems. Under Nixon we spent about 14% as much as we do now, adjusted for inflation, and the outcomes weren't dramatically different. Our cost growth exceeded European cost growth starting around 1980, and part of the reason is that our GDP increased faster. With increasing incomes, we could pay more, and health-care workers got paid more (doctors and nurses aren't going to see their incomes stagnate when their patients keep getting wealthier). Since most of our health care is private sector, it didn't have to compete with other government spending priorities that would weigh service against other government priorities like retirement, welfare, and garbage pick-up.
Among other reasons for the lack of cost control is that health-care remains craft work, so it's resisted automation and other efficiency improvements that boosted much of the rest of the economy over the same period. Add to that defensive medicine with over-testing and over-treatment, and that patients are reluctant to question the need for tests and have little financial incentive to do so when they're not directly paying the costs.
But wouldn't that also apply to people who aren't insured against kidnapping by Columbian FARC rebels? If the insurance costs more than the risks justify, then people won't take out the policy. Insurance companies work to keep the costs in line with the risks through a variety of statistical methods, but what Obamacare does is try and force uninsured people to buy insurance to expand the risk pool, meaning the uninsured aren't going to get realistic rates, but are instead being tapped as a source of revenue. That alone says the risk/benefit calculus is going to be even more strongly against carrying insurance.
One of the snags in the whole Obamacare concept was the debate over requiring insurers to accept pre-existing conditions. Insurance can't do that and still be insurance, because insurance works against risk, not certainty. If they are required to cover pre-existing conditions then it doesn't make sense for <i>anyone</i> to carry insurance because their payments won't start until they get injured, and their payments will end the moment their treatment is over. Given that, the insurance companies needed to make sure that everyone <i>must</i> be insured at all times, and the government did industry's bidding.
Pre-existing conditions require a different logical structure, such as a health loan that can't be dismissed with bankruptcy, or some other mechanism that would retain the financial costs (as an incentive for everyone else to carry insurance).
Yes, he disagreed with the decision and sided with the dissent, which held that the mandate was unconstitutional. Justice Robert's contorted decision was that the mandate <i>has</i> to be a tax, otherwise all of Obamacare gets thrown out, which is what the Court would have ruled.
So either the mandate is a tax, or there is no mandate.
This is actually a good thing for everybody, because if the government can force you to take part in a private transaction to affect interstate commerce, they can force you to pick cotton on a privately owned plantation so enough blue-jeans and T-shirts are flowing across state lines, even though you don't want to pick cotton, don't like picking cotton, and are upset that you are forced to pick cotton in perpetuity.
First of all, I do not understand your health loan argument. Just because the damage and the costs are high doesn't imply that you cannot insure it.
Chronical illnesses aka "pre-existing conditions" are one reason for universal healthcare. If it is optional you run into adverse selection problems, i.e. if you are young and want insurance you signal to the the insurance company that you are sick you so their average fees increase and so on and in the equilibrium only high risks might be insured.
Now there is a downside to forcing everybody into being covered and you mentioned it already. Insurance always destroys your incentive to take care of what you are insured against, even if it is your own health. With universal healthcare insurance companies cannot screen their customers anymore, there is a fixed fee or tax or whatever for everyone.
So there is a trade-off between an adverse selection and an adverse incentive problem. Either insurance is private and only sick or old people might get coverage or insurance is public and people take less care of themselves. Yet in the latter case you can amend the outcome via subsidizing everything that is good for your health respectively taxing everything which is bad.
If people have fire insurance they have less incentives to prevent fire so let's subsidize (reduce VAT taxes of) fire extinguishers. If people have health insurance they have less incentives to take care of their health so let's tax stuff like e.g. fat (like in Denmark).
You guys in the US do not really have universal health care. What I had in mind for my purely theoretical argument was a health care system which is totally in the hands of government like in Scandinavia. Perhaps not coincidentally their fairly clear-cut system, far less muddy than yours or the one in my own country, produces pretty good outcomes.
Oh, the idea of a health loan is similar to what would happen if people tried to get car insurance after they'd had a wreck. Normally with insurance you're paying prior to the occurance of an event, one that may or may not happen, and your payments are based on the expected costs of the event and the statistical likelihood of it.
Once the event has occured, it's no longer a risk but a certainty. That means the insurance company knows they'll incur the full cost of damages, so logically they should charge you that full cost and a little more. So you should be paying for the full cost of the damages whether you go through an insurance company or not, and by cutting out the middle-man you're better off paying it out of pocket.
For example, if you weren't carrying full coverage on your car and hit a tree, you don't go crying to an insurance company, you pay out of pocket or take out a loan and pay for the repairs over time.
Sometimes these costs will exceed what you could possibly pay (getting a loan on a terminal illness is not going to work any better than insurance for a pre-existing condition), and that's where the rest of society will have to foot the bill. (And who wants to be denied health-care because of a bad credit score under a loan model?)
But people should pay what they can, in principle, to lessen the burden they're placing on others, but just as importantly as an inducement to have been carrying insurance before the condition or accident arose. The catch there is "pay what they can" which we wouldn't want creating a nightmare layer of government-mandated paperwork that would force sick people to justify their financial existence.
Under the insurance model, we're asking insurance companies to pretend that they didn't know the accident had already happened, so even though you're going to end up costing them a lot of money, you get to make little payments as if nothing was wrong in the first place.
That's something that is not insurance, and should be handled by other mechanisms. Since we already have insurance companies that pay for accidents, injuries, and sickness, and we're familiar with them, we're trying to shoehorn a completely different need into their business model, kind of like a monkey beating a square peg into a round hole. It's never going to fit right, and we're badly distorting both the concept and business of insurance, with ripple effects that everyone will have to deal with. When you use the wrong tool for a job, the job comes out poorly.
Secondly, when you start trying to use insurance companies primarily for income redistribution instead of "insurance", the whole thing goes out the window because the low-risk people (young workers with the least assets) are getting screwed.
Your notion that the problem of pre-existing conditions somehow transcends insurance is ridiculous .
They are no problem in the case of universal health care as all people are covered during their entire life.
About redistribution, first of all there is always redistribution in insurance from the undamaged to the damaged ones. Second, I am young and healthy and do not mind to partly pay for the young, sick and old. Other folks paid for my health while I was young and will pay for my health when I am old. It's not even a matter of solidarity, just a simply zero sum game.
Letting some poor fuck with a chronic disease die is on the other hand just blatantly wrong as there is an easy solution that could avoid it.
Just take a look at some health stats yourself, universal healthcare is more efficient than private healthcare and the distribution of health outcomes is more even. It's a no-brainer, the cake is bigger and more evenly distributed.
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Half the care? The US spends a higher fraction of GDP than any other nation on health and yet achieves a lower life expectancy than these wicked Western European uber-socialist European countries.
Always the same thing, right-wingers have to deny facts to be able to sustain their ideology.
Wrong again. Under universal health care you are simply covered. Nobody makes cost/benefit calculations, you can be chronically ill, not work at all, cost millions and yet you are still covered. Something which cannot be said about one sixth of the population of the US.
Lovely story about the immigrant by the way. Strange that you do not realize that there is something wrong with the system if doctors have to cheat like this to keep people alive.
I prefer a world where the well-being of my brothers and sisters does not dependent on such moral choices that have to trick the system. I do not want people to be dependent on the charity of others, I want the problem to be solved systemically.
Why don't you tell us about Obama's death panels?
Euthanasia has little do with the question of how you finance healthcare. It has more to do with respecting the wishes of people who do not wanna live in a comma or endure heavy pain during their last months and the question of how sick people can commit respectively pre-commit to such a life-ending choice without doctors or their relatives being able to mess with that.
American Hispanics have a longer life expectancy than people in Sweden, France, Germany, Austria, Canada, or the UK, so you need to look at something other than health care to explain why the US as a whole only matches Denmark.
There are demographic factors (black life expectancy is lower due to heart disease), obesity, and the fact that the US lists pretty much every premature birth as a potential death whereas Europeans list them as non-viable miscarriages, which has a huge effect on the life-expectancy calculation. (Everyone has thrown up their hands on extracting any meaning from infant death calculations, the fact we have lots of Hispanics whose potential infant deaths get counted against Mexico instead of the US might explain part of their higher official life expectancy here.)
A few years ago the Europeans bragged that under their socialized medicine they had finally exceeded the average height of Americans, proving their health-care systems were better than ours, not realizing that the tallest group of Americans are, you guessed it, blacks.
Uh, yeah, right. Read all the screaming in the British papers about the pressures to cut costs, reduce care, and shoot patients up with lethal doses of morphine without consulting them or their families.
The doctors aren't cheating, they're just not actively killing the patient or withdrawing food and water (as is done in Europe).
And that's the problem. The wildly differing circumstances and fates of humans can't easily be solved systemically. Personal decisions and choices still have to be made, and removing choice and decision making by giving everyone a wall full of 3-ring binders which are only disobeyed under penalty of law, in an attempt to appease accountants sitting in a basement in Washington (a city that can't even keep its own lights on), is a highly dubious move.
Why don't you tell us about Obama's death panels?
If you'd bother to read the bill (that nobody has yet read) Those are in sections 3403 and 10320. A House subcommittee voted to repeal them in a bipartisan 17-5 vote, (and how can Democrats be voting on something that doesn't exist?) but so far as I know, no further action has been taken.
But in Europe it has a lot to do with people screaming about tens of thousands of patients being euthanized without their consent or even the knowledge of their families, just so the government can save money or the hospitals can free up beds. Remember, the government isn't just saving the costs of long-term care, it's saving Social Security and public pension money, too.
It's not tens of thousands, it's hundreds of thousands and we Europeans do not merely murder old people in their beds, we also eat babies. 
If there were anything factual in here I would respond seriously but debunking some right-wing Alex Jones style conspiracy nonsense is hardly worth my time.
If there were anything factual in here I would respond seriously but debunking some right-wing Alex Jones style conspiracy nonsense is hardly worth my time.
It's valid under the taxing power, which may or may not be the same thing as a tax. Essentially, it's what the Constitution considers a tax rather than what Congress considers a tax. There's no contrast between Congress not passing a tax and upholding it under the taxing power because it's a different method of analysis.
I don't know if that will have any strange legal ramifications, such as that fines are often set by the executive or judicial branches but taxes are set by the legislative branch, which might mean that HHS would lose a lot of the control they would otherwise have because they don't have the power to levy taxes.
