Health Care Reform Supreme Court Case

EdsonNascimento

The whole law is going to be struck down. We'll have to wait for final decision, but I don't see any other way.

I do find it humorous that Kagan is trying to be a legislator by saying we can find a core tenet of the bill unconstitutional, then decide which other parts are effected. That's legislating. And that's not what the Supreme Court is supposed to be doing. Either the law is unconstitutional or it is not. The Supreme Court MUST leave it at that. Anything else is impinging on the legislative branch.

It would then be up to Congress to pass a NEW law for any valid pieces of the legislation.

It is beyond me how Kagan was not forced to recuse herself from this case in the first place.

Whether you agree with this outcome or not, I think you have to agree that once the provision is struck down, it is not up to the Supreme Court to decide which pieces are still valid.

drinkbigredinstead

EdsonNascimento wrote:

The whole law is going to be struck down. We'll have to wait for final decision, but I don't see any other way.

I do find it humorous that Kagan is trying to be a legislator by saying we can find a core tenet of the bill unconstitutional, then decide which other parts are effected. That's legislating. And that's not what the Supreme Court is supposed to be doing. Either the law is unconstitutional or it is not. The Supreme Court MUST leave it at that. Anything else is impinging on the legislative branch.

It would then be up to Congress to pass a NEW law for any valid pieces of the legislation.

It is beyond me how Kagan was not forced to recuse herself from this case in the first place.

Whether you agree with this outcome or not, I think you have to agree that once the provision is struck down, it is not up to the Supreme Court to decide which pieces are still valid.

_

I called in February to try to get an appointment with a specialist. I was told their next available appointment is in 2013. And before I can schedule that, I need to see my primary care provider for a referral. His next available appointment is in June.

That's all I'm gonna say about the U.S. healthcare system right now.

brianlux

_ wrote:

I called in February to try to get an appointment with a specialist. I was told their next available appointment is in 2013. And before I can schedule that, I need to see my primary care provider for a referral. His next available appointment is in June.

That's all I'm gonna say about the U.S. healthcare system right now.

I'm sure many of us have had that same experience. Need to see a specialist, need the referral, wait several weeks or more to get in, wait and wait and wait in the waiting room to get in. They say they were booked, sorry for the wait but you see no one else leaving the place. You finally get in there and they whisk you through a short series of questions. They give you a prescription or send you to physical therapy.

By the time you finally either get the problem fixed or learn to live with it, other stuff starts falling apart. So you figure- the hell with it-- go out and buy some super glue and duct tape. That ought to hold you together for a while.

Yes, health care in America. What else can you say?

Johnny Abruzzo

brianlux wrote:

_ wrote:

I called in February to try to get an appointment with a specialist. I was told their next available appointment is in 2013. And before I can schedule that, I need to see my primary care provider for a referral. His next available appointment is in June.

That's all I'm gonna say about the U.S. healthcare system right now.

I'm sure many of us have had that same experience. Need to see a specialist, need the referral, wait several weeks or more to get in, wait and wait and wait in the waiting room to get in. They say they were booked, sorry for the wait but you see no one else leaving the place. You finally get in there and they whisk you through a short series of questions. They give you a prescription or send you to physical therapy.

By the time you finally either get the problem fixed or learn to live with it, other stuff starts falling apart. So you figure- the hell with it-- go out and buy some super glue and duct tape. That ought to hold you together for a while.

Yes, health care in America. What else can you say?

But keep the government out of it - it works just fine!

To be honest, at this point my family has great health insurance. My support of Obamacare is really in case something terrible happens down the road. Without PPACA it's so easy to be up shit's creek, or one medical emergency from financial ruin.

EdsonNascimento

brianlux wrote:

_ wrote:

I called in February to try to get an appointment with a specialist. I was told their next available appointment is in 2013. And before I can schedule that, I need to see my primary care provider for a referral. His next available appointment is in June.

That's all I'm gonna say about the U.S. healthcare system right now.

I'm sure many of us have had that same experience. Need to see a specialist, need the referral, wait several weeks or more to get in, wait and wait and wait in the waiting room to get in. They say they were booked, sorry for the wait but you see no one else leaving the place. You finally get in there and they whisk you through a short series of questions. They give you a prescription or send you to physical therapy.

By the time you finally either get the problem fixed or learn to live with it, other stuff starts falling apart. So you figure- the hell with it-- go out and buy some super glue and duct tape. That ought to hold you together for a while.

Yes, health care in America. What else can you say?

This is a ridiculous distortion of facts and the problem with the whole debate. What kind of specialist is he looking for? That one is the only one of its kind? C'mon.

a) This has nothing to do with insurance
b) This would only get worse (if anything) with a National plan


Regardless, the point is, if you had a MANAGED CARE coverage, and you let them know the issues you were having, they'd help you. More healthy members provide greater profit (if that's what you think their sole motive is), not lingering ones that exacerbate. And if your PCP is not seeing you, that's most likely a contractual no-no that your plan would like to know about.

Both issues raised here are problems with PROVIDERS, not the carriers. Those providers become gov't workers (in effect) under a national plan. Do you think that creates greater incentive for them to work or less?

I don't see how the referral you both are alluding to has effected anything since you both say the providers you want to see won't see you. Isn't that the problem? What does that have to do with the referral?

Johnny Abruzzo

Dude managed care is garbage. When I was in an HMO it was impossible to get anything done. Now in a PPO and see whoever I want and it's great. There's a reason people rebelled against HMO's in the 90s.

Also the savings that managed care generated were a one-time thing, and once it was implemented their health inflation was the same or worse than traditional plans and PPO's.

EdsonNascimento

Johnny Abruzzo wrote:

Dude managed care is garbage. When I was in an HMO it was impossible to get anything done. Now in a PPO and see whoever I want and it's great. There's a reason people rebelled against HMO's in the 90s.

Also the savings that managed care generated were a one-time thing, and once it was implemented their health inflation was the same or worse than traditional plans and PPO's.

Wrong and wrong. Trend in the HMOs are at similar levels to PPOs. But, 2 things"

1) It's starting from a lower number (i.e. 10% of 200 is less than 10% of 400)
2) Regulation has gotten in the way of actually doing effective things for patients. If you knew the amount of beuracracy put on Managed Care plans, you'd blanche.

I will re-iterate - the DEMOCRAT Governor of NY State has determined that Mandatory Managed Care is the most cost efficient delivery of care for Medicaid members.

Impossible to get anything done? Give me 1 example. Please.

And BTW, PPO's have FAR Greater profit margins than HMOs. HMOs have their margins regulated via mandatory minimum Medical Loss Ratios (ie the percent of medical cost vs Premiums must be a certain level). PPOs have no such thing. Additionally, because PPOs have larger premiums, even if the %'s were the same, the profit would be greater. Plus, less overhead. So, have at it. Insurance companies love folks like you. It's like lamb to a slaughter.

They get the easy contracting of discounts (vs. hard rates), and pass the "losings" on to their premium paying customers.

My guess is what most folks see as HMO's are really bastardized versions due to the regulations and ridiculous encumberances.

Johnny Abruzzo

Anyone see Scalia talking about the Cornhusker Kickback. Which didn't even make it to the final PPACA bill. Time to retire old man.

Johnny Abruzzo

EdsonNascimento wrote:

Johnny Abruzzo wrote:

Dude managed care is garbage. When I was in an HMO it was impossible to get anything done. Now in a PPO and see whoever I want and it's great. There's a reason people rebelled against HMO's in the 90s.

Also the savings that managed care generated were a one-time thing, and once it was implemented their health inflation was the same or worse than traditional plans and PPO's.

Wrong and wrong. Trend in the HMOs are at similar levels to PPOs. But, 2 things"

1) It's starting from a lower number (i.e. 10% of 200 is less than 10% of 400)
2) Regulation has gotten in the way of actually doing effective things for patients. If you knew the amount of beuracracy put on Managed Care plans, you'd blanche.

I will re-iterate - the DEMOCRAT Governor of NY State has determined that Mandatory Managed Care is the most cost efficient delivery of care for Medicaid members.

Impossible to get anything done? Give me 1 example. Please.

And BTW, PPO's have FAR Greater profit margins than HMOs. HMOs have their margins regulated via mandatory minimum Medical Loss Ratios (ie the percent of medical cost vs Premiums must be a certain level). PPOs have no such thing. Additionally, because PPOs have larger premiums, even if the %'s were the same, the profit would be greater. Plus, less overhead. So, have at it. Insurance companies love folks like you. It's like lamb to a slaughter.

They get the easy contracting of discounts (vs. hard rates), and pass the "losings" on to their premium paying customers.

My guess is what most folks see as HMO's are really bastardized versions due to the regulations and ridiculous encumberances.

What companies even offer HMO's anymore? It's either an expensive PPO or a cheaper consumer directed plan.

You're clearly exaggerating with your 400 vs 200 thing.

Ok, want an example? I was trying to get my feet looked at. Went to the PCP, asked for a referral. Was "capitated" (there's an HMO term :roll: ) to one guy. Got an appt months later. Show up in the crazy crowded waiting room. Go back, he says, "where's your x-rays?" Um, nobody told me to get x-rays ass hole. I can't do anything without x-rays. Why doesn't your secretary tell me this? Come back with x-rays - good bye.

I just gave up and eventually (maybe a year later) my feet got better. I self diagnosed that some soccer shoes I was wearing caused the problem. Good thing it wasn't serious

EdsonNascimento

Johnny Abruzzo wrote:

What companies even offer HMO's anymore? It's either an expensive PPO or a cheaper consumer directed plan.

You're clearly exaggerating with your 400 vs 200 thing.

Ok, want an example? I was trying to get my feet looked at. Went to the PCP, asked for a referral. Was "capitated" (there's an HMO term :roll: ) to one guy. Got an appt months later. Show up in the crazy crowded waiting room. Go back, he says, "where's your x-rays?" Um, nobody told me to get x-rays ass hole. I can't do anything without x-rays. Why doesn't your secretary tell me this? Come back with x-rays - good bye.

I just gave up and eventually (maybe a year later) my feet got better. I self diagnosed that some soccer shoes I was wearing caused the problem. Good thing it wasn't serious

Your first point is a valid one, and one I was sort of making. That's part of the problem (though I don't think we need TRUE HMO's, but let's not digress since it appears we're making progress). The 200 vs 400- both are way too low. And, obviously, the relativity depends on where you are. There are actually places that HMO per se doesn't necessarily work. But, 10% is still greater for 400 than 380 (or whatever you want to choose). The point is the same.

As for the X-Rays - again - what does that have to do with the HMO? You pointed out yourself you ended up at an icompetent office. But - did you ask if you needed anything when you showed up at your appointment? At what point do we take responsibility for ourselves? Which gets us to the last point -

Why should my tax dollars have to pay b/c you buy boots that are too small or don't fit properly? So, you didn't need a medical opinion after all. How does that prove your point that the health care system is broken? It seems it proves that there's unnecessary over utilization clogging the system. The Managed Care company was stupid (in hind sight) for granting the approval. They should have denied your ass and said - hey, dummy - get better cleats (don't really mean that. Just pointing out that you got a referral approved for something that turned out to be non-medical in nature. So, how was that limiting care?)

The only think you can point to is the capitated network. So, the issue is - doctors looking for profit by not participating? Isn't that what we are disparging the insurance carriers for? This is Podiatry. With all due respect to the specialty - they are a dime a dozen. (And no, don't start the Seinfeldian pimple popping thing. Podiatrists are critical to care especially for diabetics and the like. But, there are a lot of them).

Johnny Abruzzo

And the capitated network is garbage. If podiatrists are a dime a dozen why can't I pick out a good one? Yeah, I should've asked what I needed to bring beforehand, and should've bought better cleats. You asked for an example.

I feel like we're arguing about something that's 10-20 years old - HMO's are an endangered species. Companies that are interested in containing health inflation are using consumer directed, which is a Republican idea that I support, in theory at least.

One HUGE issue I have with RomneyCare/ObamaCare - purchasing a castrophic policy doesn't satisfy the indiv mandate (at least in Mass). I have no problem with saying I'm just going to pay out of pocket for all this dinky shit that comes up, but if I break my leg in a car accident then THAT's when I need medical insurance. Democrats don't seem to exactly understand what "insurance" means.

Cliffy6745

Alright, getting into this late. What is the consensus? From reading (and I have been very sick for most of the week so it hasn't been enough), we came into the thing assuming it would be easily upheld but things have gone downhill. I don't really take the tough questioning as a negative, that's their job to get to the bottom of it and figure out how and if it is acceptable. Plus, how much do the oral arguments really matter? It's not as much the argument as it is the actual law, sure a great performance could help but what it comes down to is the bill itself.

So I think may agree that if the mandate fails a lot of the rest will fail. It will cripple insurance companies too much.

That said, is there any chance that if this does fail, single payer is back on the table at somepoint since the Republicans have brought absolutely ZERO alternatives to the table? Especially if Obama gets a second term. We can't go on with 50 million uninsured Americans.

I also read a commentary that the timing of this is perfect for Obama, there will be 5 to 6 months of the election cycle left when the decision comes down which is an eternity and Romney can't debate him on healthcare as it is so it isn't a huge deal for is reelection as it may seem.

My gut tells me they're being tough but it gets through.

mikepegg44

Johnny Abruzzo wrote:

And the capitated network is garbage. If podiatrists are a dime a dozen why can't I pick out a good one? Yeah, I should've asked what I needed to bring beforehand, and should've bought better cleats. You asked for an example.

I feel like we're arguing about something that's 10-20 years old - HMO's are an endangered species. Companies that are interested in containing health inflation are using consumer directed, which is a Republican idea that I support, in theory at least.

One HUGE issue I have with RomneyCare/ObamaCare - purchasing a castrophic policy doesn't satisfy the indiv mandate (at least in Mass). I have no problem with saying I'm just going to pay out of pocket for all this dinky shit that comes up, but if I break my leg in a car accident then THAT's when I need medical insurance. Democrats don't seem to exactly understand what "insurance" means.

actually if you have car insurance it probably covers this if you don't have medical...at least my policy does.

Johnny Abruzzo

mikepegg44 wrote:

Johnny Abruzzo wrote:

And the capitated network is garbage. If podiatrists are a dime a dozen why can't I pick out a good one? Yeah, I should've asked what I needed to bring beforehand, and should've bought better cleats. You asked for an example.

I feel like we're arguing about something that's 10-20 years old - HMO's are an endangered species. Companies that are interested in containing health inflation are using consumer directed, which is a Republican idea that I support, in theory at least.

One HUGE issue I have with RomneyCare/ObamaCare - purchasing a castrophic policy doesn't satisfy the indiv mandate (at least in Mass). I have no problem with saying I'm just going to pay out of pocket for all this dinky shit that comes up, but if I break my leg in a car accident then THAT's when I need medical insurance. Democrats don't seem to exactly understand what "insurance" means.

actually if you have car insurance it probably covers this if you don't have medical...at least my policy does.

Yeah, good point. Ok, how about you get diagnosed with cancer.

Johnny Abruzzo

Cliffy6745 wrote:

Alright, getting into this late. What is the consensus? From reading (and I have been very sick for most of the week so it hasn't been enough), we came into the thing assuming it would be easily upheld but things have gone downhill. I don't really take the tough questioning as a negative, that's their job to get to the bottom of it and figure out how and if it is acceptable. Plus, how much do the oral arguments really matter? It's not as much the argument as it is the actual law, sure a great performance could help but what it comes down to is the bill itself.

So I think may agree that if the mandate fails a lot of the rest will fail. It will cripple insurance companies too much.

That said, is there any chance that if this does fail, single payer is back on the table at somepoint since the Republicans have brought absolutely ZERO alternatives to the table? Especially if Obama gets a second term. We can't go on with 50 million uninsured Americans.

I also read a commentary that the timing of this is perfect for Obama, there will be 5 to 6 months of the election cycle left when the decision comes down which is an eternity and Romney can't debate him on healthcare as it is so it isn't a huge deal for is reelection as it may seem.

My gut tells me they're being tough but it gets through.

I think there may be a media overreaction to what looked like a couple bad days for PPACA. I like your optimism about bringing back single payer if it's overturned. I just don't see it happening. I think we'd go on like we were for another 30-40 years before somebody else tried to tackle it. Republican obstruction on this issue has been going on for almost a century (if you count Social Security).

When it's off the table everybody loves single payer, but then when somebody tries to actually pass it all of a sudden it's the end of the fucking world.

mikepegg44

Johnny Abruzzo wrote:

mikepegg44 wrote:

Johnny Abruzzo wrote:

And the capitated network is garbage. If podiatrists are a dime a dozen why can't I pick out a good one? Yeah, I should've asked what I needed to bring beforehand, and should've bought better cleats. You asked for an example.

I feel like we're arguing about something that's 10-20 years old - HMO's are an endangered species. Companies that are interested in containing health inflation are using consumer directed, which is a Republican idea that I support, in theory at least.

One HUGE issue I have with RomneyCare/ObamaCare - purchasing a castrophic policy doesn't satisfy the indiv mandate (at least in Mass). I have no problem with saying I'm just going to pay out of pocket for all this dinky shit that comes up, but if I break my leg in a car accident then THAT's when I need medical insurance. Democrats don't seem to exactly understand what "insurance" means.

actually if you have car insurance it probably covers this if you don't have medical...at least my policy does.

Yeah, good point. Ok, how about you get diagnosed with cancer.

well actually if you get diagnosed in your car I think you will be covered
sorry, don't know why I did that, I understood your point, I hate when people do that...


I have never fully understood catastrophic or major medical and what they cover...I would think that would be catastrophic but I think like a normal person...not an insurance company...I had major medical for a time but thankfully never had to use it
I am very disappointed that the members of congress didn't take the time to figure out that by creating this mandate it may be unconstitutinal, they were putting in jeopardy all of the parts of the legislation that are good and that people already depend on. Selfish, butt covering pricks

EdsonNascimento

Johnny Abruzzo wrote:

And the capitated network is garbage. If podiatrists are a dime a dozen why can't I pick out a good one? Yeah, I should've asked what I needed to bring beforehand, and should've bought better cleats. You asked for an example.

I feel like we're arguing about something that's 10-20 years old - HMO's are an endangered species. Companies that are interested in containing health inflation are using consumer directed, which is a Republican idea that I support, in theory at least.

One HUGE issue I have with RomneyCare/ObamaCare - purchasing a castrophic policy doesn't satisfy the indiv mandate (at least in Mass). I have no problem with saying I'm just going to pay out of pocket for all this dinky shit that comes up, but if I break my leg in a car accident then THAT's when I need medical insurance. Democrats don't seem to exactly understand what "insurance" means.

Well, if you break a leg in a car accident, the health insurer shouldn't pay anyway. That's a property/casualty coverage called...auto insurance.

As for the network - that's my point. If the other podiatrists accepted the rate the capitated ones did, they'd all be in the network. Therefore, there are podiatrists looking for higher rates than the market will bear. Isn't that the definition of profiteering? Again, I'm not begrudging anyone. But, how does the gov't fixing rates help the podiatrists that were unwilling to enter the network in the first place?

And you can pick out a "better" one - pay for it. Those other Podiatrists are not the insurance you purchased. Nobody's stopping you. And, you even indicated you don't mind paying the small stuff. So, where's the issue? It sounds like you made a wise Insurance purchase. You just didn't execute your decision to its fullest. Saying, everyone's on board does not solve that issue (it would just drive up your insurance premium). You may have ended up with a crappy podiatrist anyway. I am sure there were other pods in the network you could have chosen that would not have treated you that way. Who's fault was it for not researching the podiatrist?

And CDHP are dead. Yeah, there's a pocket of them. But, if they were going to take over, they would have already. That concept is over 10 years old, and it has very little market share. It doesn't work b/c it's lipstick on a pig (the pig being Indemnity plans). Long term actuarial projections will tell you CDHP drive up cost, not decrease them. The only decrease you see is in the first year maybe. After that the cost shoot past exisiting Indemnity/PPO plans.

EdsonNascimento

Johnny Abruzzo wrote:

mikepegg44 wrote:

Johnny Abruzzo wrote:

And the capitated network is garbage. If podiatrists are a dime a dozen why can't I pick out a good one? Yeah, I should've asked what I needed to bring beforehand, and should've bought better cleats. You asked for an example.

I feel like we're arguing about something that's 10-20 years old - HMO's are an endangered species. Companies that are interested in containing health inflation are using consumer directed, which is a Republican idea that I support, in theory at least.

One HUGE issue I have with RomneyCare/ObamaCare - purchasing a castrophic policy doesn't satisfy the indiv mandate (at least in Mass). I have no problem with saying I'm just going to pay out of pocket for all this dinky shit that comes up, but if I break my leg in a car accident then THAT's when I need medical insurance. Democrats don't seem to exactly understand what "insurance" means.

actually if you have car insurance it probably covers this if you don't have medical...at least my policy does.

Yeah, good point. Ok, how about you get diagnosed with cancer.

Well, your HMO would cover that.

EdsonNascimento

mikepegg44 wrote:

well actually if you get diagnosed in your car I think you will be covered
sorry, don't know why I did that, I understood your point, I hate when people do that...


I have never fully understood catastrophic or major medical and what they cover...I would think that would be catastrophic but I think like a normal person...not an insurance company...I had major medical for a time but thankfully never had to use it
I am very disappointed that the members of congress didn't take the time to figure out that by creating this mandate it may be unconstitutinal, they were putting in jeopardy all of the parts of the legislation that are good and that people already depend on. Selfish, butt covering pricks

Well, let's be fair - nobody gave them time to read it before passing it. So, there's only a handful you can say that about. The rest that voted Aye! without reading you can just call incompetent.