SCOTUS Upholds Affordable Care Act!

Athena - I couldn't agree with you more that there's no such thing as a free lunch.  Yes, other people pay when an uninsured person receives care.  But, with "universal health care," other people pay when an uninsured person receives care.  If it bothers you to pay for other people to receive health care, then why not support free market solutions instead of universal health care?

Alexandria -  ALL sources have a bias.  Politifact is considered left-leaning, which is why I posted it here for you.  As I pointed out, however, the article tries to be balanced.  It concludes that there is some evidence to support the number, but there's also credible evidence against it.  The point is, people repeat these numbers as if they're given facts without even questioning them.

How many deaths are too many? you ask.  I've already answered that question earlier:  To me, ONE death is too many.

But, anecdotal evidence is just that - anecdotal.  They are tragic stories, and they make me sad, too.  But they don't prove anything.  They merely drive our emotions.  There are stories of insured people dying in the dentist's chair.  Look at my signature.  My family has been ravaged by cancer.  I could share many anecdotes of family members who were insured - and still, medical mistakes were made, and they perished.

Really, though, I myself am in a difficult financial position.  If the rest of you want to pay my bills, go right ahead.  You don't seem to mind.     This whole plan isn't going to hurt me personally.  I've never received any type of gov't assistance in my life, but now I'm thinking:  If you high-income earners want a universal health care system, you're free to pay all of my bills.

www.healthcare.gov is by far the best site on the health law. The law's provisions tend to ensure that insurance goes down, not up, but what will actually happen is anyone's guess. The Urban Institute, which is about as respectable and non-partisan a source says they will go down because of the presence of enough young people. The fact that the penalty may be hard to enforce does not mean that people won't buy insurance OR pay a penalty. The penalty/tax functions as one of several incentives to buy. Will everyone buy? Absolutely not, but I do think things will improve.

Beesie - I don't get to have opinions on these things - wage stagnation in the US is partly due to health costs as a matter of fact, but other factors weight more heavily on stagnating wages.

Life: I DO want to pay for other's care - but not at the high rate of an ER when they are in crisis. Rather, I want my taxes to keep more people healthy and away from the ER. Healthcare is the same as bridges, roads, education and peace and a standing army. We all benefit, we should all pitch in. The ACA is a far cry from perfect. It's not what I wanted, but it is better than what we have now.

Oops.... possibly another little problem in the wording of the bill:  Brawling Over Health Care Moves to Rules on Exchanges    But I'm sure that the supporters of the ACS won't believe anything written in that old Republican-leaning rag, The New York Times. 

notself, the information in your link from Kaiser is simply stating the "whats" that are supposed to happen according to the ACA.  They are regurgitating the timeline of events and changes as laid out in the bill. It all sounds great, doesn't it?  But there is no thinking or assessment on the Kaiser site.  Nor is there any discussion about "how" these changes are going to be implemented or whether the "how" is likely to happen as planned. It's the "how" that will determine whether the ACA delivers to it's goals or not. Similarly, Athena, www.healthcare.gov is a great site to understand what's in the bill but it's a site that's run by the government.  So here again they are stating simply what the bill says; they are not assessing the feasibility of what the bill says will happen. Neither of those sites are looking at the bill with the eye of an analyst to determine whether or not the implementation can actually be expected to work the way it's supposed to. 

A couple of months ago I saw an interview with the person at the CBO who was responsible for putting together the CBO's assessment of the health care bill. This person said that the lower costs that the CBO were projecting for the healthcare bill were based on assumptions that were in the bill - he explained that it is not the job of the CBO to question whether the assumptions they've been given are correct or not. They do the math using the data and assumptions they've been given. And that's the same with these websites. They are simply accepting what they are being told will happen and are parroting it out for everyone to read. 

It's the "hows", the implement and execution, that's key.  What happens if the McKinsey survey I posted earlier is correct and 30% of companies stop offering healthcare coverage to employees?  That probably will mean that the government's assumption that only 7% of employees will have to switch to subsidized plans will be wrong.  And that will increase the costs of the program. 

What happens if the Feds are stopped from offering subsidies in states where they, and not the State government, have set up the exchange?  That would mean that in those States they would not be able to penalize companies that don't offer healthcare to their employees. And that will reduce the revenues to the government. 

Just two examples of possible problems with the implementation of the bill that could have a big impact on the effectiveness of the bill.  

I'll leave it there, because I've already made the same points too many times. People who only want to see the trees are only going to see the trees, no matter how many times you suggest that they raise their eyes and look a little further out to see the whole forest.  And honestly, I really hope that I turn out to be wrong about my concerns. The problem is that I've spent an entire career where I've had to always consider and investigate all the "what ifs" and prepare for all the possible "gotchas".  I've gotten pretty good at uncovering any possible "gotchas".  I'm sure that not all the "gotchas" that I see with the ACA will come to pass, but I'm sure that some of them will.  And that will impact the results and whether the ACA is able to deliver on it's promises.

Alexandria - We don't know all of the details of the story of the man with the tooth infection.  It's very sad.  If anyone out there cannot afford the medicine they need, please tell your doctor.  I'm sure that if the man had known what would happen to him, he would've told the hospital that he couldn't afford the antibiotics.  The hospital may have been able to help him.  I would bet that the hospital staff didn't drive home the point very forcibly, probably because a tooth infection spreading to the brain might be a very rare occurrence.  Yes, as you said, mistakes happen.  As we all know, they happen whether you're insured or not.

Btw, I was just reading that, in England, which has "the oldest and largest single-payer system," dental care and prescription drugs are not covered by the NHS for everyone.  Maybe someone else here knows more about that.

Here is more information from the CBO site on its processes.

what kinds of assumptions do you make about what the Congress will do?

We take proposed legislation as it is written and do not attempt to predict the intent of future Congresses. There is no plausible alternative to that approach. All of CBO's work reflects our objective, impartial, nonpartisan judgment. That stance precludes the agency from speculating on what the Congress might do or from offering advice as to what any Congress ought to do.

That said, the agency regularly shows the effects of adopting alternative policies that have been discussed by the Congress, so that the impact of those alternative policies is clear. When the Congress considers modifying current law, CBO provides cost estimates for those modifications when they are considered.who reviews your work?

All CBO estimates and reports are reviewed internally for objectivity, analytical soundness, and clarity. CBO's reports are also reviewed by outside subject matter experts. In addition, the agency has a Panel of Economic Advisers and a Panel of Health Advisers. Those groups-whose membership includes previous CBO directors, other distinguished economists, and acknowledged experts in health care-meet to review the agency's economic forecasts and to advise the agency on its analyses of health care issues. Although such experts provide considerable assistance, CBO is solely responsible for the accuracy of its work.

The site posts the names and titles of all groups that provide input into the health care projections.

I've emboldened some things below and I've inserted some comments based on my experience living in Switzerland (my comments are in italics)

"ACA comes closest to the Swiss model - a completely private model. No govt insurance or state run hospitals. This model has been in place in Switzerland for two decades now. They operate with private providers and private insurance. Germany, Belgium, Japan and the Netherlands also cover all of their citizens in the private system. Switzerland, in the early 90s were having the same issues we have now....rising premiums, coverage for pre-existing conditions, premiums for women and the elderly being disproportionately higher and more of their citizens were giving up on insurance. One assemblywoman, who later became their President, pushed for a law requiring "the mandate," stopped insurance companies from rejecting those with pre-existing conditions and provided subsidies for those who needed them to purchase insurance. Sure does sound familiar.

As I said before, Switzerland is made up of kantons, like states. There are 26 of them. Your insurance choices and cost depend upon where you live - the kanton itself, and where within your kanton. You can receive care pretty much anywhere in the country, however, but if your treatment costs more outside the kanton, you may be asked to pay the difference. But not always - for example, if you live in Bern and have to have a medically necessary service in Zurich, then it's paid for. I had all my treatment in Bern, and now live in Zurich, but I still visit my oncologist and gynecologist in Bern. No problem.

Anyway, there is the basic insurance - compulsory for everyone, and it's quite extensive. It's all that I have. There are also supplimental products - and that's where the insurers make profits. But these products are very restricted, and you don't get them with pre-existing conditions. They're also expensive. Between 85 and 90% of people here have just the basic. I moved to Switzerland at 52. With no history here, and some pre-existing conditions, neither my husband nor I qualified. I know mostly younger expats with some supplimentary insurance.

There are state-run hospitals. THe kantons run hospitals where everyone can receive care. There are also private hospitals - for some you have to have additional insurance, but for others, if your physician practices there, you're there. For people with basic insurance, you may be in a 4 person room, but it depends on the facility. I went to a private hospital because my physician practiced there, and I was in a 4 person room once, a 2 person room the other time. Absolutely spotless, very nice facility, decent food, great nursing staff. My father in law was in a small community hospital for a few days. Spotless again, great care and a view of the mountains.

The basic premium for women is a little higher. But it's not much higher. Less than 10%.  

Fareed said it was an uphill battle to pass this legislation...squeaked by Parliament, got a 52/48 positive vote in a National Refurendum. Ms Dreyfus: "Nobody was really happy, but everyone could accept."

Twenty years later (reported):

**Everyone is now covered and the care is top notch.

**The Swiss enjoy one of the longest healthiest life expectancies.

**The access to healthcare is easy (Swiss Minister of Health)

**Hospitals have become more like 5 star hotels. (Swiss Minister of Health)

Hospitals are very nice, not exactly 5-star hotel nice. Food's a lot better than in the US. Spotlessly clean. Big windows and lots of great views ( a happy accident of nature). Some of the private clinics are more like hotels, I imagine.  

**World reknown for choice to users - hospitals, doctors....

**No waiting to see Specialists

It is easy to see specialists, but some of them insist on a referral from another doctor, and you might wait a month or so for a non-urgent case. My diagnosis, surgey and the start of chemo was all within a month, which was perfect for me. If I have an urgent matter, I can see the oncologist usually within a day or two. I once had to go to the ER on the weekend for a fungal infection - waited 15 minutes. (I called first), was out in another 15. 

Another small thing - it's not a problem to call a doctor, ask for a letter, fill out a form, etc because all of this is covered under insurance.They're not doing it on their own time.

** Health insurance isn't linked to employment. Can change your insurer each year. Too many choices!

This is very true, but most people don't change. You have to send a registered letter by Sept or Oct 30, and it's too much bother for a lot of people. 

** Healthcare costs are 11% of GDP - "they're still working to make the law better." One complaint was that the Swiss were offered so many choices for insurers each year, they didn't take the time to look at the most cost savings plans."

  There was a referendum this year to make people who didn't go to primary care for a referral, or didn't use an HMO to pay more. It didn't pass. Inertia is strong.  Costs are rising, however. Still less than the US. 

Per Fareed, the Swiss model went above and beyond Obamacare. Insurance companies, before the law was passed, were prohibited from making a profit over Basic Health Care. Under the new law, they had to expand that basic package.

There's also some profit-sharing among insurers. If you make too much money on your basic plans, you have to somehow share the money with the other providers of basic plans at the end of the year.  Imagine that! That's just for basic, however.

It's not Nirvana.There is disparity based on where you live. Some of the more rural areas have fewer specialists, and hospitals that don't offer all of the services, so you may travel farther for care. Access may be an issue if you live on a mountaintop. I know people who are not satisfied with the treatment - they usually live in more remote areas and have to go through a GP first.  Like the US, your care is likely better in the cities, near universities, etc. 

Costs are determined by kanton. I pay more in Zurich than Bern. And although I have the same coverage as anyone with compulsory basic insurance, my insurer may or may not offer better customer service.  We've kept the same insurer for 5 years, they do our reimbursements quickly. I've not had a single problem with anything. And there are no stupid co-pays, just a flat 10% up to $700 out of pocket, including drugs. 

Having said that, there is some weirdness. For example, I have to pay for my own yearly flu shot. But it's like $20.Transport between facilities or to facilities is not well organized, and can be expensive. 

Some Americans don't like it here - they feel there are too many nit-picky rules. I don't, i think it's rather more fair. 

Dental care is more expensive here, and dental plans are tough to get into. I see my dentist in the US if I can. Also eyecare (glasses, etc), but more essential eye stuff (retina, cataract, etc) is covered under basic insurance. 

Remember that Switzerland has 8 million people, whereas the US has 300 million, and the insurance lobbies are very strong in the US. Implementing a program like this in the US will be a huge undertaking. Not that it shouldn't be attempted, but still... I think that people will need to be both patient and insistent. And it probably won't save money at first, but over time......

Mardi - don't you want to ask what they're spending on healthcare via taxes and premiums?  One gets other things, besides healthcare, when they pay taxes.  I found this:

Highly regarded systems in Sweden ($4,252) and France ($4,798) manage on two-thirds the Swiss spend. These figures reflect exchange rates. The disparity in costs between Switzerland and other European nations is not so great by another measure – the proportion of national wealth spent of health. In Switzerland, total health spending amounts to 11.4 per cent of GDP (US 17.4 per cent, UK 9.8 per cent). 

http://www.telegraph.co.uk/health/expathealth/9264375/Expat-guide-to-Switzerland-health-care.html 

This is also a cradle-to-grave system, so no Medicare. 

Edot- thanks for elucidating!  Do you have a sense of other European systems comparatively speaking?

Quick note - I am a crappy typist - I corrected the spelling of the web site I recommend in my earlier post, but here it is: www.healthcare.gov - it's the guvmint's site and very easy to navigate.

On voting: There are many countries in which citizens can cast a "blank" vote. It would be great if we had that option here. It says: "I came, I saw, I conquered (the voting booth) and you are all useless tossers." It would save as a wake up call, especially in local elections, I think. The blank vote tallies are counted and published.

Kam - Massachusetts has roughly 7 million residents...close to the Swiss numbers. I'm trying to get a sense of Mass state taxes vs. Swiss fed taxes. comparing anything at the fed level wouldn't be fair given our huge fed infrastructure.

I said I wouldn't post again but notself, you completely misunderstood my point.

I know what the last CBO report said, projecting that costs will be lower (if you read my post you'll see that I even referenced that fact), and I understand the extensive process that the CBO uses to come up with their numbers.  My point was simply that if the CBO is handed legislation that says that 7% of employees who are currently covered by their employers will end up being subsidized, the CBO uses that 7%. They don't investigate the feasibility of the 7% and conclude that in fact the number is more likely to be 15%. They build their cost estimates, which go through the very strenuous and objective process that you describe, based on the 7%.  In the quotes that you provided, when they use the word "estimates" they are talking about estimates within the CBO data itself, not estimates provided by the government within the legislation that serve as the base for the cost estimates that the CBO develops. 

And no, I didn't miss the little flags on the Kaiser site that indicate which parts of the bill are already implemented.  

It's amusing to me that some of those who are criticizing and challenging me on my research and analysis of the ACA, including making comments that suggest that I must be a complete idiot, are the same people who have sometimes praised my research and analysis skills when it comes to issues about breast cancer.

I want the bill to succeed.  I hope that the everyone in the U.S. gets complete healthcare coverage.  I don't have a stake in the game - I'm Canadian and I gladly pay taxes for my healthcare coverage and I receive excellent (but imperfect) care. From a political standpoint, I support the positions of the Dems on some issues and I support the positions of the Repubs on other issues.  However I strongly dislike the tactics of both the Democrats and the Republicans on healthcare and many other things - frankly I'm disgusted by the spin, and outright lies, coming from both parties. I am thankful that I can't vote in the U.S. election because I don't know what I would do. To net it out, I think I came to this discussion with very little bias (unlike most who are here). It's an topic that interests me greatly so I decided to use my research and analytical skills to dig into the ACA so that I could understand more about it and wouldn't be relying on the spin that's put out by either party. I didn't know what I would find. I'm disappointed and concerned about what I've found. And I've just been reporting what I've been finding.    

Over and out, this time for sure. 

Just doesn't make sense to compare the total tax rate of a state versus a nation, especially if you are just interested in health care.  I posted what the Swiss spent on healthcare (combination of taxes and premiums) versus United States, but whatever.

You can put regulations into place to control red tape and prevent fraud without the direct government involvement and costs associated with the ACA.

Beesies,

You said: "If the ACA actually had a hope in #@!! of delivering even just half of what it promises, I'd be all for it. I agree with the objectives.  I don't support the ACA because I don't think that the ACA will deliver on those objectives."

Then you said: "the information in your link from Kaiser is simply stating the "whats" that are supposed to happen according to the ACA.  They are regurgitating the timeline of events and changes as laid out in the bill. It all sounds great, doesn't it?  But there is no thinking or assessment on the Kaiser site.  Nor is there any discussion about "how" these changes are going to be implemented or whether the "how" is likely to happen as planned."

From these statements, I had assumed you had not spotted the flags which indicate that the ACA is in fact being implemented, aka delivered, on time as projected. Now you say that you saw the flags and are insulted that I pointed them out to you. Something is strange here. 

You said that the CBO does not analyze the data given but just regurgitates it.  I pointed out the careful and thorough processes the CBO uses to analyze the data.

You brought up a bunch of hypothetical situations and proceeded to complain that the CBO did not make up hypotheticals and address them.  Well, that is not the job of the CBO.  There are hypotheticals that need to be considered but that is what congress and politics is about.  Those hypotheticals are being argued about in congress and our politics.  Yes, this is not very pretty to watch, but this is how we roll.

alexandria5,

Thank you for your apology.  My brother's needless death is still very raw for me.  His type of cancer was very curable had he had proper health coverage to begin with.  He was too young for Medicare, made too much money for Medicaid and as a self employed person could not get insurance coverage he could afford and still feed his family. Once he was diagnosed, he could not get coverage on any terms.

When I was laid off from my company and my husbands health issues became so bad he could not work, we lost our insurance.  My husband could go to the VA but I could not get insurance because my previous doctor had inaccurately diagnosed me as having osteopenia.  The insurance companies I applied to would not give me a policy because I had a "preexisting condition".

My husband's health deteriorated to the point he was declared 100% disabled due to the effects of Agent Orange.  I then became eligible for health care through the VA.  It is a scary thought that my husband had to have his health ruined by war for me to get coverage.  Without the VA, I would be dead.

I'm so sorry Notself...that shouldn't happen in the world's richest country. It's an outrage.

The fact that your brother could have been medically helped but had no access to help at a crucial time points to what happens when there isn't routine care available to everyone. And as with most illnesses, it isn't the sort of situation he could have resolved at an ER. They would have sent him home after making him wait 10 hours.

I hope any anti-health-coverage-for-all people reading this will take note. People are dying or going bankrupt every day to stay well after getting ill threough no fault of their own and in ways they couldn't have predicted. This isn't at all like having a house on a beach in an area prone to hurricanes and then not getting storm insurance.