SCOTUS Upholds Affordable Care Act!

Mardibra · July 2012

Who did I insult?

Chickadee · July 2012

Not self, agree with your observations. I don't think we've really gotten to anywhere close to beginning to work towards resolutions. I think the conflict is going to get uglier. Sadly.

Our expanded access to information is a blessing and a curse. So many ways to manipulate it. And so many gullible readers who want simple sound bites so they don't have to think.

alexandria58 · July 2012

I don't think that the controversial times began in the 60's. There were always deep divides. It was just more hidden. We have a cultural myth of a harmonic world in the 50ies. But take a real look at the 1950's : there was McCarthism, segregation,the cold war, the roles of women were tightly defined, anti-semetism was still accepted, a decade after the Holocaust.

Many of those things - restrictions on African-Americans, women, Jews, and others existed throughout the early 20th century.

Maybe television just made the struggles more visible, maybe it made prejudice less palatable.

I do believe that the health insurance conflict right now is just the reaction to imminent change. I do hope that with time, and success, and if necessary tweeking of the law, more and more people will accept the change - just as it happened with integration, with the change in women's roles.

grayeyes · July 2012

Life: You said one death was too many. You make that statement but seem unwilling to accept the fact that people who cannot afford doctor's visits are less likely to have diseases caught in early stages, who cannot afford medicine are not going to buy it, and instead claim that the specific examples of deaths from lack of health care, Noself's brother, the man with the tooth infection,were caused by mistake or by their own inability to find the right charity care. You said one death was too many, I gave specific examples of three - apart from the question of the reports of excessive deaths.

Alexandria - When I said that my own family has been ravaged by cancer and that relatives who were insured perished due to medical mistakes, YOU brushed that off by saying, "Yes, people will get cancer, and will still die. Medical mistakes will happen." But, for some reason, you find it a greater tragedy if a mistake is made on someone who was uninsured (such as the man with the infected tooth).

Question: When (or if) we are all insured under either the ACA or a universal healthcare plan, what will you say then when a mistake happens?

In an earlier post, I talked about my OWN experience as someone with a pre-existing condition (before breast cancer). I talked about how I always wanted to see reform - just not this kind of reform. I talked about the role I wanted to see the gov't play when private insurance wouldn't cover me: As someone who would never have qualified for Medicaid or Medicare, all I wanted from the local gov't office at that time was some direction: Where do I go? Who can I check with? Just give me some advice. Instead, their whole attitude was: "Just go into debt." So, please do not even try to suggest that I don't understand what it's like to be in that situation.

Again, you don't know the real reason the man with the infected tooth didn't buy antibiotics. Walmart sells antibiotics for $4 to people who have no prescription coverage. Maybe he didn't know about that program. Or, maybe he didn't think he really needed antibiotics. Many people (myself included) have been prescribed antibiotics and didn't buy them because we didn't want to take them. IOW, the story about the man with the infected tooth is very rare - dying from an infected tooth is very rare. That wasn't supposed to happen. But now his story is being to be used to further an agenda...

grayeyes · July 2012

Notself - My family's experience with the VA was just the opposite of yours. And there have been other negative reports about the VA. It seems to depend on the VA hospital. Also, it sounds like you had a digital mammogram. That's the same type of mammo that I had, and I have private insurance; the results were available immediately. But not all radiology facilities have that technology; luckily, my gyn told me about the technology, and I looked it up and found the place that had it.

Kam - Your experience with delays over the holidays sounds just like mine. I kept having to push and push for testing, appointments, surgery, etc. And, then, when January came around, I had a new deductible all over again.

Moderators - Thank you for the work you do. This forum is very much appreciated. It's nice to be able to talk about something besides breast cancer.

ananda8 · July 2012

lifeiswonderful,

Dying of an infected tooth is quite common but unrecognized because the death certificate says heart attack. Yes, heart attacks have been linked to infection particularly to tooth infection. Assuming that WalMart had its $4 for antibiotics plan in place, what antibiotic is effective against tooth infections and how would the average person know without going to a doctor?

I understand that you are uncomfortable with the ACA but you haven't said which parts specifically you are uncomfortable with. Are you uncomfortable with the part that stops insurance companies from rejecting patients with preexisting conditions? Are you uncomfortable with the part that provides support for hospice care? Are you uncomfortable with the "tax" on free loaders who refuse to buy insurance coverage? What specifically are you concerned about and what is your suggestion for a fix? If you have covered this in you previous posts, I am sorry, I must have missed them. Please be so kind as to repeat your positions. I am interested in knowing more about your opinions because I have yet to fully form my own.

grayeyes · July 2012

Kayb - No. Charities could decide to list with local offices. Then, if someone is denied Medicaid, for example, that person can be pointed in another direction. All they'd have to do is provide a list of charities or other organizations that are willing to help. I've already explained my own experience in an earlier post: I was insured but had a pre-existing condition (not BC) and lost three months of care. The local gov't assistance office was no help at all. I called hospitals, but they wouldn't quote me a price estimate. Finally, I found a low-cost program at a hospital on my own.

Incidentally, has anyone else here ever been uninsured with a pre-existing condition? Or am I the only one? Maybe I missed someone else's story.

Notself - According to the reports I've read, it is uncommon to die from a tooth infection today, although you will hear about it in the news once in awhile. The man in question went to the hospital, and they gave him two prescriptions - one for antibiotics and one for painkillers. Again, I don't believe for a second that the doctors told this man he could die from an infected tooth if he didn't take antibiotics. If they had, he would've either bought the antibiotics or asked someone for help. He probably had no idea how serious a tooth infection could become. Most people don't know. I myself have had two wisdom teeth pulled, and no one told me I could die, either, if I didn't take antibiotics. Now this man's tragic story is being used to serve an agenda.

I have already given my own opinion on the different parts of the ACA. However, at some point, the discussion switched from the ACA to universal health care. If you're talking about the ACA specifically, then, as I've stated earlier, I have no problem with certain parts of it - such as raising the age to 26 to be included on your parents' policy. The main part that concerns me is the individual mandate. And, for the record, I myself have nothing to lose... According to what I've read, my family would (for the first time ever) finally be on the receiving end of the deal. So, all this is no sweat off my back. As I wrote earlier, if the rest of you want to pay my bills, who am I to argue with you? I'm concerned about where it's all headed - toward universal health care - but most of you here are in favor of universal health care. It doesn't matter what argument the rest of us make or what information we give you. Those in favor of it aren't going to change their minds.

ananda8 · July 2012

Here is two of several links about tooth decay and heart disease. http://www.abs-cbnnews.com/lifestyle/11/25/10/tooth-decay-can-cause-heart-problems

http://www.buzzle.com/articles/tooth-decay-and-heart-disease.html

"Tooth decay, also known as dental caries or dental cavities is a disease of the teeth, which finally results in the damage of the teeth. Tooth decay is caused by bacteria which are present in the plaque. This bacteria extracts sugars from the food particles and converts it into lactic acid and stores them in the cavities present in the teeth. This can lead to the decaying of teeth. There have been many researches which show the connection between decayed tooth and heart disease."

What do you propose to replace the mandate/tax? It is my understanding that the mandate/tax is one of the sources of funding for the ACA that enable insurance companies to drop their restrictions on preexisting conditions and allowing children to stay on the parents policy until the kids are 26. There is plenty of time to think of something else since this part of the ACA does not go into effect until 2016.

We already have a program of government run health care that Americans love. Unfortunately it has an age restriction. It's called Medicare. One is not required to use it, but one is required to pay into the system. I guess this requirement is a mandate.

corgi09 · July 2012

lifeiswonderful, My sister was diagnosed with MS at 26. She died when she was 54. She never had health insurance. She had to get a divorce and live on her own in a wheel chair to qualify for aid to get into a nursing home. I also have a brother that did alot of stupid things and has HepC. He has been clean and sober for 27 years. He had insurance when the economy was good but when he had to lay so many employees off his company lost the group coverage. His co. is recovering but he hasn't been able to afford his high blood pressure meds for 4 years. My son broke his elbow 2 days after we had to drop him from our insurance. He got a 7 hr wait, a $2800 Xray and a referal to a bone surgeon that wanted $600 to walk thru the door. That was his ER treatment. I know more about this than I want to.

alexandria58 · July 2012

Lifeiswonderful: The issue with the man and the infected tooth was one of three examples I gave of deaths that could have been avoided with insurance. I just gave three examples as illustrations of lives that could have been saved with health insurance, the man with the infected tooth was one. Again, I was responding to your statement that one death was too many, and your response is to argue that the people who died could have done something else. Maybe. Still, it is clear that they died because they didn't have money and didn't have insurance.

I do not think that these people's deaths are more tragic than others except in the fact that they could have been avoided. It is the fact that of unnecessary deaths that is infuriating.

Yes, I'm outraged by medical mistakes, too, that cause unnecessary deaths, and I am saddened by all premature death of anyone. It is tragic when people die without living a full life (which I define as around 90 years old) from cancer or other diseases. Still, sometimes those deaths could have been avoided. There will always be bad outcomes from procedures that were done competently by physicians, but when deaths occur because of mistakes from the negligence, the deviation from standard care of doctors or hospitals and a life is lost that could have been saved, I believe in legal action to take those doctors to court, not only to recover for the family but to try to influence hospitals to use best practices, and to punish bad or incompetent doctors.

And, when someone dies who could have been saved for lack of health insurance, then I believe our society needs to change how we provide health insurance.

To me, it's a little like watching someone drown in front of you when you know how to swim, even if it somehow inconvenient for you to save him. Your good clothes get ruined, you're late for a meeting, but you save a life. That's why I'm for universal health care, and why I support the ACA, even though it doesn't have everything I wanted.

Finally, your solution of having charities to pick up the slack isn't really feasible. Charity clinics are not in every town, in every state, many are strapped for money because there are too many people without insurance. By the way, an ABC article on the death of the cincinnati man from the tooth infection quotes a dentist who runs free dental clinics in San Diego saying he can't take any new patients.

There is always fear of change. Every major change over the past 100 years had been fraught with anxiety, and I do understand that people of good will can fear something new. But the status quo cannot stand.

AnneW · July 2012

Subacute bacterial endocarditis. The lining of the heart can become infected from the mouth bacteria, and it is not a pretty death. I have witnessed it, but not in many years. By the the heart lining is infected, a simple ten day course of a $4 antibiotic ain't gonna cut it. You need the big drugs, IV, for 6 weeks. They don't keep people in the hospital for that lentgth of time and treatment any more. You go home with a pic line and home health. If your insurance covers it. If you have insurance in the first place.

There's been a lot of yammering about access to care. That is, and has been, a huge issue for decades. Access involves more than physical locality, obviously. But that's a huge impediment, if you live in one of the many rural poor areas (think Indian reservations, Appalachia, delta south.) THese are the places few providers are willing to go to, except for a couple years to pay off big student loans.

Then you have the issue of access but can't afford. We all know about that one. Who gave that great example about sitting outside the gated community in their car (or such?) My trainer is self-employed. Makes a fare wage. Has a catastrophic insurance policy with a high deductible. No spouse for a premium insurance plan from work. She blew a disc in her back recently and has been paying out of pocket for her PT and her one doctor visit. Can't afford the MRI recommended. Or hell, sure she can, but she might not make her rent. And she can't work extra hours due to her pain and inability to move to train others. Her fault, I hear some people say. Suck it up.

So, yeah, we have a big problem with health care--access, delivery, and payment--in this country. I see this debate as really being a discussion of our national values. The ACA is but a tiny step forward. Many people are already benefitting, more will in a year, and we can call "the sky is falling" all we want right now, but it just might NOT fall. In the bigger picture, the sky IS falling. Shame on us for not doing more.

alexandria58 · July 2012

AnneW: A thoughtful response.

Anonymous · July 2012

I think I am missing something in the current discussion. Does the ACA cover dental care? Most medical insurance does not, so the guy with the infected tooth would still have to pay out of pocket for the timely supposedly inexpensive care that could have saved his life. A visit to most dentists is far more expensive than any normal antibiotic prescription, so I am not sure how that would work.

Then again, if he chose not to fill the prescription for an antibiotic when the tooth was bad enough to send him to the hospital emergency room, what kinds of other bad decisions was he making? Did he tell the doctor in the emergency room that finances were an issue, so could the prescription be for a generic antibiotic? When he found out that the antibiotic was more than he was willing to pay, did he ask the pharmacist about alternative things he could do? Could the pharmacist have called the prescribing physician and gotten a different (less expensive) option? Could the pharmacist have let the guy know about Wal-Mart? Or Target which also has a low cost drug program? Did the pharmacy have any program to help the uninsured?

That story is not about a lack of health insurance, it is about a lack of common sense on the part of many people, with a very sad outcome as a result.

gardengumby · July 2012

Patmom, lifeiswonderful and Mardibra - I'm curious, what specifically do you dislike about the affordable care act?

Anonymous · July 2012

alexandria58wrote:"To me, it's a little like watching someone drown in front of you when you know how to swim, even if it somehow inconvenient for you to save him. Your good clothes get ruined, you're late for a meeting, but you save a life. That's why I'm for universal health care, and why I support the ACA, even though it doesn't have everything I wanted. "

Alexandria, the very FIRST thing that is taught in lifeguard training is that you don't just jump in to save someone because it is far more tragic when the rescuer drowns along with the swimmer who got into trouble. That means that the second rescuer on the scene has to decide which victim to try to save first, and may wind up losing both.

Rescuers are taught to keep themselves safe while helping the swimmer who is in trouble. Making the wrong decision about how to help can make the situation much more difficult.

That is where we disagree. You figure that doing something, anything, is better than doing nothing, while I believe that doing the wrong thing can make the situation much worse rather than better.

We both want the same outcome, but want to take a different route to get there.

gardengumby · July 2012

What route do you want to take?

alexandria58 · July 2012

Lifeiswonderful: You are so focused on this one case because you do not want to admit that people without health care are much less likely to have conditions caught early, are much more likely to not receive treatment or medication because it is unavailable or too expensive. With many health insurance plans, medication is discounted or free. And maybe this particular incident of the man with the infected tooth could have been handled differently. Whatever. It doesn't change the basic fact: that people have poorer outcomes without insurance. There have been posts to that effect on this thread.

lassie11 · July 2012

Let's say that in this case that the drowning person is in a situation that would allow for the lifeguard to make a safe recovery. Then what? Would lifeguards never make a rescue just in case it might be dangerous for them? Or would they value their responsibility and skills enough to help?

QuinnCat · July 2012

Patmom - I haven't read through all of these posts on the "infected tooth," but saw your question about whether ACA covers dental care. I don't know the answer to this question definitvely BUT I will say this about my federal employee insurance that often gets cited as and "you will get the same type of health insurance as members of Congress and federal employees"....the answer is that dental and optometrics are NOT covered unless they are medical situations. A tooth infection might be covered--they would pay for pulling the tooth and the anitibiotics. They would not pay for the followup bridge or the implant.

Between glasses, optometric exams, 2 teeth cleanings a year, I spend well over $500 a year out-of-pocket and this does not count toward any deductible or catstrophic amount. That's why I always laugh when they refer to Congressmen's "Gold Standard" healthcare insurance (they have the same as us). Recently, OPM, made a dental/eye package available, but like most dental plans, they are not really cost/benefit effective.

Anonymous · July 2012

Gardengumby, if you had read my posts on the subject, you would know that:

I think the law was poorly written, so there is too much room for administrative rules to change the implementation of the law from the intentions of the legislators who proposed it in the first place. Some of that happened even before it got through Congress.

I don't think it addresses the basic problems with access to care, and that it in fact makes that access less likely for many people.

It focuses entirely too much on making sure that people have insurance rather than making sure that they have access to care.

It significantly expands the reach of the federal government in ways that won't be easy to undo. Precedent is important, and once it is set, it applies no matter who controls the White House and Congress.

It costs too much.

It fails to deliver good value for the price.

It is one of, if not the biggest tax increase in the country's history at a time when the economy is in trouble, and has been unable to get out of that trouble for years now.

It is totally the wrong approach to solving the health care mess in this country.

It puts the health care access of those who have it now in jeopardy.

It is just generally a bad, poorly written law that we will regret for decades to come.

It does have some good points, but those good points would be very easy and popular to put into other legislation that doesn't make such fundamental changes in the way the government functions in the average American's daily life.

I choose to live in the USA. If I wanted to live in a country with a socialist government, I would have moved to one years ago.

alexandria58 · July 2012

I said inconvenient, not life threatening. So, if you're an expert swimmer and are walking by a pond and you see someone drowning, but you have a meeting, or you're wearing expensive clothes that you don't want ruined. You could save that person, but it would be inconvenient. That's the metaphor I was using.

Perhaps the difference here is that I see the objections to universal health care as being mainly about costing too much (hence, inconvenient) or at worse resulting in some waiting for non-emergent conditions, such as knee replacements. You seem to be fearing that it will cost lives. Maybe that's the essential difference. I don't see universal health care, or the ACA as threatening anyone's life, but since you seem to, your resistence is more understandable, even if I don't agree. My only response to that is that countries that have universal health care such as let's say Switzerland, which the ACA has been compared to,have excellent outcomes, no waiting. Switzerland is 3rd in the world for life expectancy, whereas the US is 43 or so. Thus, the ACA is more analogous to my metaphor than to yours.

Anonymous · July 2012

Lifeguards are taught to reach, throw, row, go with support. Extend a pole, a towel, or a hand from the safety of land. Throw a life ring or buoy to support the victim and pull them in to shore. Use a boat to get close enough to the victim to extend an oar. ONLY swim out to a victim after removing excess clothing that will weigh you down, and with a flotation device that you can use to help get that victim safely back to shore.

That is far less dramatic and flamboyant than jumping into the water fully clothed and pulling the victim to safety barehanded, but far more likely to end up with the desired result.

kayfh · July 2012

And the ACA while not perfect is actually a perfect metaphor for the reach, throw row go plan for lifeguards. No, not every person will benefit completely. But each will have at least a reasonable chance at being rescued. Fully 25% of Amercians have no chance without ACA.

gardengumby · July 2012

PatMom, I had read your posts, I've read this entire thread, and even with the above I'm not exactly clear on what you don't like.

You say it doesn't address access to care. Yet, most people IF THEY HAVE INSURANCE do have access to care. Therefore, ensuring the populace has health insurance also ensures access. Does the law say all doctors MUST accept insurance and/or medicare? No, it doesn't - but you can bet your bottom dollar that would have NEVER made it through Congress.

You also say that it "puts the health care access of those who have it now in jeopardy". If you are saying that it's possible that employers that currently offer healthcare may begin to drop that - yes, that is certainly possible. However, you earlier state/imply that access to insurance is not access to healthcare, so I'm not clear on how having insurance is not access to healthcare for people who currently have no insurance, but it is access to healthcare for people who do currently have insurance.

The CBO says that it will save money - not cost money.

Exactly how is it a tax increase? The penalty "tax"? That is the only tax increase that is in the ACA.

If it is totally the wrong approach - then what in your opinion is the "right" approach?

The ACA is not in any way socialist. Just how is it that the ACA "makes such fundamental changes in the way the government functions in the average American's daily life"? The state I live in says I MUST have auto insurance. So, I purchase auto insurance. That doesn't mean the state government has intruded into my daily life. How is it that you think that because the Federal government says "you will have health insurance or pay a penalty" is intruding into your every day life?

pupmom · July 2012

Our current system is totally and irrevocably BROKEN. We have the most expensive health care in the world without universal coverage, and with poor life expectancy considering the amount of money we spend. I would have preferred a single payer system, but that would not have made it past Congress. ACA is a start and we need to move on, improve it where we can, and make sure that as many people as possible have affordable, accessable health care.

ananda8 · July 2012

Wow, what a lot of points to cover. Your comments are in bold.

I don't think it addresses the basic problems with access to care, and that it in fact makes that access less likely for many people.

Yes it does. It provides incentives for doctors to enter the primary care and incentives for working in areas of low medical service. It also has programs for RNs and to assist RNs to get their Master's Degrees so there are more teachers of nursing.

It focuses entirely too much on making sure that people have insurance rather than making sure that they have access to care.

See above.

It significantly expands the reach of the federal government in ways that won't be easy to undo. Precedent is important, and once it is set, it applies no matter who controls the White House and Congress.

Please explain the parts that won't be easy to undo and why they may need undoing. Any law that has been passed can be modified, just look at the tax code.

It costs too much.

The CBO has said that it will probably cost less than projected and the costs are offset by revenue from other changes. http://www.cbo.gov/search/apachesolr_search?keys=aca&op=search

It fails to deliver good value for the price.

Please provide your sources for this statement. Since it is just starting to be implemented this comment seems to be opinion rather than fact.

It is one of, if not the biggest tax increase in the country's history at a time when the economy is in trouble, and has been unable to get out of that trouble for years now.

Rush L. got a rating of "Pants on Fire" for this falsehood. http://www.politifact.com/truth-o-meter/statements/2012/jun/28/rush-limbaugh/health-care-law-not-largest-tax-increase-us-histor/

It is totally the wrong approach to solving the health care mess in this country.

What would you like to see done to control costs and increase health care coverage?

It puts the health care access of those who have it now in jeopardy.

Please provide a link supporting you statement.

alexandria58 · July 2012

We are moving away from the employer insurance model if we do nothing. More and more employers were dropping or limiting health care insurance even before the ACA. Many new jobs did not offer health insurance. More and more people are being hired as per diems, as part times, so that benefits do not have to be offered, and that started before the ACA.

Those who are so comfortable with their current employer provided plan should be aware that the employer can change or eliminate the plan.

Of course, there's those who get laid off....

Patmom, this is insurance provided by private companies, not government provided insurance or healthcare - which is why so many progressives wanted a public option and why so many insurance companies wanted this kind of system. Explain just how this is socialism.

crazy4carrots · July 2012

From the Merriam-Webster on-line dictionary:

Definition of SOCIALISM1: any of various economic and political theories advocating collective or governmental ownership and administration of the means of production and distribution of goods2a : a system of society or group living in which there is no private propertyb : a system or condition of society in which the means of production are owned and controlled by the state3: a stage of society in Marxist theory transitional betweencapitalism and communism and distinguished by unequal distribution of goods and pay according to work done************** It's often a good idea to know what certain political terms mean before actually using them. There are several countries, including my own, which are accused of being "socialist". None of the above definitions actually applies.

Wabbit · July 2012

Saying that the ACA is in any way socialist is a huge fallacy. It is actually very capitalist in that it concentrates on selling and buying private insurance as a way for people to pay for care. The government will merely set some minimum standards, set up an exchange for people to efficiently shop for insurance and provide some subsidies for the cost.

So how do you propose achieving an increase in access to health care? I'm curious because I can't think of a single way that would not be much more 'socialist' than what the ACA offers. More free or reduced cost clinics? Who would run that or pay for it? Surely not the government ... that might be socialist.

Charity? Can't force charity and even the well intentioned ones sometimes have money and sometimes don't. That's why the mishmash of 'help' out there now is almost impossible to navigate. Depends on where you are ... and what disease ... and if funds are available at that particular time. And finding such things is like looking for a needle in a haystack ... while in the middle of a health crisis.

So do you think the best plan is to just let the current system continue to implode until there are so many people who have lost their health insurance and/or cannot pay for health care that the lack of customers forces the price of medical services down? Frankly that only helps the people who already have access.

Chickadee · July 2012

Business interests have wanted health care dumped on the government for decades. I remember 30 some years ago when Verizon, then under a different name as a baby bell sent us all letters with the new language that basically said " we can dump you whenever and however we want". A couple reasons they havent, i think is there is still an active union including a retiree club and they are still profitable enough. Bad publicity hampers decisions as well. However each contract they go after benefits every time. There was a lot of negative publicity and outcries about companies that cut off health care that had been promised to their retirees. Just dumped it and left the rest of us to pick up the tab for now indigent retirees who hadn't reached 65 yet. I have a couple friends who retired from IBM who always raved about their benefits until IBM cut them to ribbons and imposed budget busting fees. They struggled until age 65 and Medicare.

I know too many young people working 2 or 3 low wage jobs in retail who can't qualify for any benefits. College degrees notwithstanding.

While many companies cover long time employees often now they are grandfathered and new employees have little hope of receiving benefits as everything is rewritten to make access unlikely. Another aspect of business looking for ways out is the lack of interest in keeping an employee long term. The idea of working 20 or 30 years for one employer is now a quaint memory. I knew one lady working for a law firm let go just before she qualified for their health insurance. That's another common trick in the working world.

Many of us on here have benefits based on employer commitments of many years, but the trend to make access to health care through work more difficult to achieve is rapidly leaving more and more citizens without access. We are on a downward slope for those coming behind us.

It's really the same argument had since our government was formed. Either we expect government to provide services believed to be better for the majority for which we pay taxes, or we want little government or taxes and subscribe to the idea of self reliance for everything.

SCOTUS Upholds Affordable Care Act!

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