Capitol Hill Blue Forums Political Issues Constitutional Issues The Supreme Court and ObamaCare's Demise?

I don't care what happened in Texas, a statewide model does not work as a comparison. I am open to another idea, if you have one. So far we have eliminated Obamacare and single payer because one will be ruled unconstitutional and the other will never get through Congress. If we also rule out national group insurance, what can be done? I will surender this piece of ground for the sake of this argument, it might be possible to get something done short to medium term, but it has to have buy in from both parties.

The fatal flaw in Obamacare was the way it was passed, the deals that were made and the agonizingly long time it took in Congress. By the time it was "passed" there were so many people pissed off that it was a wonder that it actually got out of the House. You will argue that Obama tried to compromise, but my memory says that he played up to the press and just pissed the reps off more. But I will even tell you that I won't argue your point, if it makes you feel good, it was the Republican side of the aisle that screwed up.

Now, any solution?

There are about 700,000 physicians in practice in the US. Assume arguendo that each of them needs malpractice insurance (not true of VA and military doctors, I believe.)

Assume further that each doctor has to pay $25,000 for insurance annually. TOTAL insurance premiums for the nation would be less than $20 billion. In 2010, we spent over $10 trillion on health care.

If you totally erased all of the premiums for malpractice, that would equal about 2 tenths of one percent of total medical expenditures. That is 0.002.

Faced, with this analysis, is there anyone who wants to make the argument that reforming or even doing away with malpractice insurance costs would have any effect at all on medical care costs?

You've been mislead on the cost of tort issues related to health care. Politicians have been paid huge sums by insurance and medical providers to create a diversion as opposed at looking at the real problems. It's so very small in the grander scheme of things. So for the sake of moving on...I'd like to take Tort Reform off the table.

What's the solution?

First Step - get the hands of big biz out of the government's pocket.

Second step - the only way to rule out national insurance would be to add insurance companies to the Sherman Anti-Trust Act and allow any company that is financially capable of jumping in the health insurance providers list and compete EVERYWHERE any US state and/or territory. That includes insurance companies from abroad.

And...

Lastly, If financial, insurance, and market institutions can collaborate and/or engage in the business of creating securities and derivatives, then the same needs to apply to insurance companies when it comes to health care insurance. If banks want to underwrite insurance, if Goldman Sachs wants to underwrite health insurance...why not?

But the catch is...major insurance reform will be necessary. Why? The insurance industry is driven by "two key figures":



In other words, STOCKHOLDERS LOVE VIRTUAL MONOPOLIES! And especially if they have such a profound stop-loss ability built into their business practice

Kudos to all for for a civil and informative discussion.

I have to disagree Austin R

i think you are looking at this backwards

just as any gambling scheme, insurance only works on the principle that they will make money regardless of their payout. I think it is easier to target insurance companies rather than 700k doctors or 50k hospitals as the culprits. But if you notice the cost drivers are not simply insurance but physician costs, high tech testing, drugs, hospitals and insurance has to accommodate all of those increasing costs, deliver some service, and manage premium costs.

even with real competition between insurance companies, premiums will never be lower than their projected payouts. Let's look at an example:
suppose we use the current system of employer provided health insurance. Those premiums are not only correlated to HC (health care) costs but the price is a causal result of HC costs. Even if there is "real" competition I don't believe there would be any significant reduction in premium costs, but there may be some. Premium costs will continue to rise in direct relationship with HC costs as they rise.

Now suppose we can add a significant number of previously uninsured. These will be a mixture of relatively healthy people and relatively HC dependent people. The only advantage in relationship to premiums is if the healthy people significantly outnumber the HC dependents. And suppose that is the case. Initially costs would be reduced but as HC costs continue to rise, so also would the premium rates. (Consider the converse that the newly insured actually cancel each other out ... yikes ... notice one could find an equation to describe these added variables but the point is at the time these people are added we will find ourselves in the same spot as before)

No matter how you slice and dice this issue from the insurance perspective, premium costs will continue to rise.

I believe the proper approach is to find ways of reducing HC cost drivers (physician costs, hospital costs, drug costs, high tech testing costs, etc), and if anyone believes tort reform will do the trick, then they don't understand the problem.

I started up a new topic for the cost of health care and insurance so that this thread can focus on the role of the Supreme Court on this issue.

RP...

Dunno, man. It's complicated, but one thing is for sure. As long as Congress can cloak the insurance industry...protect its almost monopoly status...then we'll never know what "TRUE COMPETITION might lead to.

Back to the Supreme Court.

Question: Recently Obama publicly voiced his opinion as to what he believes the courts decision will be (or should be). Have the more conservative Justices taken his comments as an almost preemptive measure to set the court up in such a way that the Court will appear to be overstepping its role and balance of power boundaries if they rule against the Health Care Act?

As you all recall, Obama truly pissed off the "conservative" Justices during a State of the Union speak where he called out the Court, in front of the nation, for Citizens United v.FEC. On January 21, 2010, the Supreme Court released its landmark decision in Citizens United v. FEC. The Court upheld the First Amendment rights of individuals acting through corporations and labor unions to participate in our political process, and it struck down what was called an oppressive thicket of statutes restricting - and even criminalizing - their political speech.

Could this be an opportunity for some passive aggressive action taken against Obama over his past comments and more recent comments about what he believes the opinion of the court will be...based on the idea that it would make the court look bad to overturn a democratic process conducted by members of government who were "elected" to be a voice of the people?

Remember that the House has 435 members. In March 2010, Democrats held a 75-seat majority. Obamacare passed by seven votes. So is the health care act really reflecting the "voice of the people"?

Yeah, that comment was recently re-played on the news.... Was Obama wrong about what he said? I mean, has that USSC decision worked out real well for the country? And it is just starting... I mean I can only wonder what elections will be like after the whole private enterprise political money machine really gets reved up.

So, do you think that things worked out as the court thought... when Roberts mouthed the words "that is a lie" as Obama made his comments? I gotta say that in retrospect, Roberts looks like an idiot to me... he apparently had no idea of the results of that decision. Can one expect better from the current case on the Affordable Care Act?

And do you really think that they give a shxt about what Obama thinks?

It ocurrs to me that this is a difficult issue.

But actually I would be pleased if you would outline a plan that could solve all our problems and get a 2/3s majority.

As I recall republicans have several times controlled house, senate and president.... what was the magic solution that was proposed? I suggest that if there was a magic solution available, the republicans could have won a lot of support by passing it... but instead not a peep.

So if the Republicans had a chance to pass a bill if they wanted, and if doing so would be to their advantage... why did they not event TRY?

My guess is that there are no easy solutions... and lots of difficult and unpopular choices to make. That is not typically the sort of situation where a bill passes with a 2/3s majority.

So, what is you opinion about the "will of the people" ... and why does no one propose such an obvious winner?

Just for correction, it was Associate Justice Alito, and he said "not true!" Alito's State of the Union moment Having said that, the ultra-conservative Scalia-Alito-Thomas (and sometimes CJ Roberts, and sometimes Kennedy) cabal on the Court has been compared to the Roosevelt-era court that essentially went to war with the New Deal. But even more disturbing to me, is the behavior of a Judge on the Fifth Circuit Court of Appeals, who went way beyond judicial decorum, and threw what can mildly be termed a "hissy fit." Republican Fifth Circuit Pitches A ...ent Obama Speaks Out About Supreme Court. Fifth Circuit to DOJ: Prove You Support Judicial Review Note, the latter is from the Wall Street Journal.