R.I.P Obamacare

[Hawkmoon]

Federal judge in Texas has ruled that Obamacare without the penalty for people who don't buy it can't be a tax, and therefore it's not constitutional.

https://www.nbcnews.com/news/us-news/federal-judge-texas-strikes-strikes-down-affordable-care-act-n948306

So much for, "We have to pass the bill so that you can find out what is in it."

[just Warren]

We lost the Weekly Standard and the ACA on the same day!?!?!

*faints away*

[Ron]

The question I have is what is the best path forward to bring the health care industry back under the discipline of market forces?

Government interference has so distorted the costs in the industry that there doesn’t seem to be an obvious way forward.

[MillCreek]

Cue up the conservatives suddenly loving those activist judges and the liberals suddenly hating those activist judges. 

[Ron]

Cue up the conservatives suddenly loving those activist judges and the liberals suddenly hating those activist judges. 

I’m down with installing activist right wing judges across the board.

The rule of law has been a dead letter for a long time.

Only conservative somnambulists haven’t woken up to that reality.

Learn the rules of the game you're actually playing and win.

[Scout26]

Cue up the conservatives suddenly loving those activist judges and the liberals suddenly hating those activist judges. 

Eh, not really.  Remember that Obamacare was determined to be constitutional because the individual mandate was a "tax" (per Roberts, even though that was NOT the argument used by the administration to the court). 

Since the individual mandate has been revoked by congress and signed by the president, it is no longer a tax.  Therefore, it has been overturned. The court has simply recognized what the law now is (not).

[zahc]

The question I have is what is the best path forward to bring the health care industry back under the discipline of market forces?

Government interference has so distorted the costs in the industry that there doesn’t seem to be an obvious way forward.

--Stop allowing companies to deduct employee benefits costs on their taxes. Allow employees to fully deduct medical insurance premiums from theirs (if itemizing).

--require medical providers to list prices for services. If the feds can make restaurants list calories on their menus, they can make providers list prices, as a transparency and competition measure.

--make policy changes to enable a healthy, nationwide market for insurance, and stop the "in-network, out of network" nonsense

a good start

[Firethorn]

--Stop allowing companies to deduct employee benefits costs on their taxes. Allow employees to fully deduct medical insurance premiums from theirs (if itemizing).

--require medical providers to list prices for services. If the feds can make restaurants list calories on their menus, they can make providers list prices, as a transparency and competition measure.

--make policy changes to enable a healthy, nationwide market for insurance, and stop the "in-network, out of network" nonsense

a good start

I'd argue that, given how few people will itemize under the new levels, that we should make insurance deductible outside of the standard deduction.  .

Next, not only make medical providers list prices, forbid "x% off of list" negotiations with insurance providers.  A contract with one customer shouldn't mandate prices for another.  Might not be necessary though with public pricing.

[Hawkmoon]

Next, not only make medical providers list prices, forbid "x% off of list" negotiations with insurance providers.  A contract with one customer shouldn't mandate prices for another.  Might not be necessary though with public pricing.

Still necessary. Unless expressly prohibited, the providers will still play games.

Some years ago, I took a then-GF to an emergency room for something. They started off saying their minimum charge was some outlandish number, then asked what she had for insurance. She said "None."

Oh! Suddenly the price was about one-third what they had said less than two minutes previously. That's just wrong.

And we wonder why premiums on health insurance are so high ...

[Scout26]

--make policy changes to enable a healthy, nationwide market for insurance, and stop the "in-network, out of network" nonsense

Why not ??   If your insurance company can negotiate better rates with hospital group "X", why not take advantage of the deal.  I agree with hospitals posting rates.  But why not offer NRA or American Legion or Insurance group "Y" discounts ??

[Ben]

I'd argue that, given how few people will itemize under the new levels, that we should make insurance deductible outside of the standard deduction.  .

Yes.

The tax deduction has always bothered me, both on the R & D sides of the aisle. The Ds want to "provide affordable health care" but did nothing to better the health care deductions. The Rs cried about the unfairness of Obamacare but did nothing regarding tax deductions - especially on the health insurance deduction limitations.

IMO, every single dollar of money spent on any health care* should be tax deductible. Whether you spend $10 or $100,000 per year. Whether your AGI is $20,000 or $20,000,000 per year.


*I wouldn't argue against an "except for" things like facelifts and other cosmetic procedures.

[MechAg94]

Cue up the conservatives suddenly loving those activist judges and the liberals suddenly hating those activist judges. 

Probably already been addressed, but how is declaring the law unconstitutional an "activist" decision.  It seems to me that is exactly what the judge should do.  The SC ruling declaring Obamacare a tax was the "activist" decision.  It essentially rewrote the law so it would be constitutional instead of dumping the whole thing.

[Ron]

Thou shalt not trespass against stare decisis or undo what the left has wrought.

Isn’t that the commandment you have to agree to obey to be on the SC?

[AZRedhawk44]

--Stop allowing companies to deduct employee benefits costs on their taxes. Allow employees to fully deduct medical insurance premiums from theirs (if itemizing).

--require medical providers to list prices for services. If the feds can make restaurants list calories on their menus, they can make providers list prices, as a transparency and competition measure.

--make policy changes to enable a healthy, nationwide market for insurance, and stop the "in-network, out of network" nonsense

a good start

I take it you've never seen ICD/CPT fee schedules before.  Medical providers don't have a fixed price for services.  Insurers have a fixed offer value per procedure, and medical providers decide whether to accept that insurance (and its fee schedule) or not.  This is why many offices only accept a fixed percentage of their patient base as Medicare patients:  Medicare has the lowest fee schedule of any insurance.

Insurance and health care won't stop increasing in cost until people divorce the notion of health insurance and health care from their heads.

[Fly320s]

Insurance and health care won't stop increasing in cost until people divorce the notion of health insurance and health care from their heads.

THANK YOU!!!!

Medical insurance was not, is not, and should not be used for routine healtcare expenses.  The fact that most of our society uses it that way is part of what is driving up healthcare costs and driving down access to medical staff.

[RocketMan]

I'm sure the SCOTUS will overturn this lower court's ruling.  I am also sure the current crop of congress weasels will "enhance" and "improve" ObamaCare to such an extent that single-payer socialized medicine will appear to be downright wonderful.

[Ben]

 I am also sure the current crop of congress weasels will "enhance" and "improve" ObamaCare to such an extent that single-payer socialized medicine will appear to be downright wonderful.

This is what I foresee. The Rs pushing the short term plans are just as bad as the Ds pushing the kitchen sink plans. 

I was looking at the alternative plans for Idaho, and while yeah, they are way cheaper than what I have now (like $200/mo vs $700/mo), they cover pretty much nothing and have like $10K/yr maximum payouts.

I could deal with, and in fact prefer them not covering minor Doctor visits and even minor surgical procedures, but the one thing I'm always afraid of, especially as I get older, is getting the cancer, or even just getting hit by a bus. Those $10k/yr plans would wipe me out and have me living under a bridge. Between the two choices, I'm stuck with the Obama kitchen sink plan. I'll never use my maternity coverage, but it will at least cover me if I'm stuck in a hospital for half a year.

I again go into rant mode that we need true and simple catastrophic care policies at a reasonable price. Instead, one side of the aisle gives a lump of coal plan, while the other side gives us diamond encrusted plans. One can't help but think if there was a free market there would be some options in between the two.

But yeah, sooner or later we'll see single payer. Which, ironically, might bring some form of "free market" back. My dad has Medicare. He thinks it sucks even though he never goes to the doctor. He's afraid if he really needs insurance it won't be enough. So he pays Blue Cross $200/mo for enhanced coverage (like the aforementioned being hit by a bus). Maybe if we end up in single payer, a market will be created to allow people to pay private insurance some reasonable monthly amounts for better service. Which I guess has sorta happened in some European countries, where people pay extra so they don't have to stand in the socialized medicine line.

[Scout26]

Health Insurance should be like car insurance.

You buy the coverage(s) you want with the deductibles you'll pay.   And go from there.  If you want barebones that covers cancer and getting hit by a bus only, you should be able to buy that.  If you want maternity care, doctor visits, and sniffle visits covered, then you get to pay for it.

YOU pay for YOUR coverage.  Not a bunch of slacker millennials nor a bunch of senior citizens.

[dogmush]

Health Insurance should be like car insurance.

You buy the coverage(s) you want with the deductibles you'll pay.   And go from there.  If you want barebones that covers cancer and getting hit by a bus only, you should be able to buy that.  If you want maternity care, doctor visits, and sniffle visits covered, then you get to pay for it.

YOU pay for YOUR coverage.  Not a bunch of slacker millennials nor a bunch of senior citizens.

That model only works if we, as a society, are willing to let the consequences play out.  You total your ride without comprehensive insurance?  Walk.  You get knocked up without maternity insurance?  You should have the birth paid off by the kid's college.  You get cancer without comprehensive coverage?  You had a good run, make peace.

The United States is demonstrably unwilling to let folks bare the consequences of poor health decisions alone.  It's just not going to happen.  Our energy would be better spent trying to get our folks on the death panels, because taxpayers ARE going to pay for everyone's healthcare.

[brimic]

Remove government regulations and involvement in the medical and insurance industry, allow people to buy whatever level of coverage they want (or not), and the costs of everything will come way down.

[DittoHead]

Medical insurance was not, is not, and should not be used for routine healtcare expenses.  The fact that most of our society uses it that way is part of what is driving up healthcare costs and driving down access to medical staff.

While I do agree with this to a certain extent, I think the waters are muddied by the fact that preventative care and dealing with those routine healthcare expenses early-on can save a LOT of money down the road. So a lot of insurance companies want you to do that stuff and their best way to encourage you to do so is to pay for it. Making people pay for that stuff out of pocket makes them less likely to do it and can end up costing more money in the long run.

[grampster]

Government has become a Nanny.  Sometimes a good Nanny and most times a bad Nanny.  The Nanny also plays favorites.  A good deal of the American people have become accustomed to Nanny or are oblivious to Nanny and those they elect are bound and determined to keep it the way it is, as well as make it worse while at the same time making it unavoidable.  Barring any catastrophe, it will not get any better.  I'm glad I'm old.  I think things will hold together till I croak.  But I feel sorry for my kids, grandkids and great grandkids.  For that reason sometimes I wish we would never had children.

PS:  I always gigglesnort when I see some of you rail against old people as if we are a drag on you.  A.  Most of you are too self centered to understand we built and paid for the platform for your life of ease.  B.  I'm glad to be a drag on you because it's fun to watch you eat that turd sandwich.  C.  You never consider you'll be the old guy some day.    D.  That's why most of us old guys think you young guys are dumb asses.  ( :rofl:LOL added as this comment was meant to be humorous)

[Ben]

You get cancer without comprehensive coverage?  You had a good run, make peace.

You know, I can't find it again, but a few weeks back I read a really interesting article (or opinion piece or whatever) about a guy who made the argument for us to stop trying to extend our lives at all costs. He said that his "target age" was 65. He would go through the colonoscopies, etc,. and even some cancer treatments up until that time, but then that was it. If he made it to 100, great. If he got the cancer or whatever, he was going to let nautre take its course. Some treatment to lessen pain only, but no chemo or radical treatments to try and extend his life.

As Dogmush said, "you had a good run". Some of us run less of a distance than others, and it would probably do good to discuss "long life" vs "good life". It would likely have some major effect on health care as well.

[MillCreek]

^^^There are interesting statistics on the total percentage of healthcare dollars spent on an individual that are spent in the last three months of life.  Quite a high percentage when you start down the ICU, etc. route to keep someone alive longer.

[AZRedhawk44]

While I do agree with this to a certain extent, I think the waters are muddied by the fact that preventative care and dealing with those routine healthcare expenses early-on can save a LOT of money down the road. So a lot of insurance companies want you to do that stuff and their best way to encourage you to do so is to pay for it. Making people pay for that stuff out of pocket makes them less likely to do it and can end up costing more money in the long run.

Manage this the same way that vehicle insurance is managed.

Drive well and with a good record, your vehicle insurance is low.

In the same way, demonstrate physical fitness and care for your body, and you get lower health insurance rates.  Gym members, proven hobbyist athletes, martial artists and such, who disclose their activities to their health insurer along with a yearly physical exam, get better rates than the reddit dwelling cheezypoof eating, vaping 50 year old trigglypuff.