Obamacare Going Down?

[Lemur]

Looks like the administration's lawyers are not faring well in front of the Supremes. Details:

CNN's legal correspondent Jeffrey Toobin reports that the court's conservative wing appeared skeptical of the Obama administration's arguments in favor of the individual mandate provision of the Affordable Care Act.

"This was a train wreck for the Obama administration. This law looks like it's going to be struck down," Toobin said on CNN. "All of the predictions including mine that the justices would not have a problem with this law were wrong."

"The only conservative justice who looked like he might uphold the law was Chief Justice Roberts who asked hard questions of both sides, all four liberal justices tried as hard as they could to make the arguments in favor of the law, but they were -- they did not meet with their success with their colleagues," Toobin said.

This gets me wondering, if the latest attempt at universal coverage is ruled unconstitutional — if the individual mandate, which is pretty much the only method for preserving a market-based system while guaranteeing coverage for most citizens, is unenforceable — what's next? Remember, the concept of the individual mandate was initially put forward by the Heritage Foundation and enacted by Governor Romney in its first real-world test-drive.

So what's next? Do we really try to disentangle government from healthcare, and strike out into uncharted waters for a completely market-based approach? Do we eventually get forced into single-payer just to keep costs under control? Do we limp along with our hybrid jackalope not-market/not-universal system for the forseeable future?

What?

-edit-

Shamelessly ganking from another thread where this came up:

The NHS provides universal cover for half the cost of the US system - there are other alternatives, but the tell is that you can have private insurrence in the UK but most people don't bother.

I assume he means half the cost per head, and I also assume he wasn't being literal.

Actually, I think he understated the case, although it's hard to make head-to-head comparisons, given that different benefits apply. Still and all, a recent, rough comparison.



I think anyone who has run the numbers can see that the US system involves the most cash for (at best) an average outcome.

Well that's pretty damning, isn't it?

Especially seeing as you wouldnt say the UK has some fabled mediterranean diet, they drink, smoke eat too much nor do they exercise blah blah and still the life expectancy is two years better with less wonga spent.

Short version of my take: Single-payer healthcare has its ups and downs, but it appears to be the cheapest method for covering the population.

A purely market-based system of healthcare may be cheaper, depending on which economic theories you choose to believe, but it has never been tried on a national scale in a developed country. (I would be a lot more confident in the Republicans who advocate a pure market system if they could point to a single real-world example. Empiricism FTW.)

Here in the USA we've managed to take the worst aspects of single-payer and fuse them to the worst aspects of a broken market system, yielding the most expensive healthcare on Earth. Yay us.

The only upside to our system is that if you have a great deal of wealth (in the form of gold-plated insurance or good old cash), some low-percentage diseases and conditions can be treated at a much higher level of competence than in any single-payer system. So if you've got some weird variant of lymphoma, and your pockets are functionally bottomless, you can buy better treatment here.

And that's about it.

[Strike For The South]

The goal should be Maximizing care while minimizing cost. The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I just want an NHS, Sorry for being fiscally respobsible

[Lemur]

The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I think this is one of the most relevant criticisms of Obamacare (and Romneycare): yes, near-universal coverage is achieved, but no big steps are taken to rein in costs. And if you compare the year-over-year increases, our system is getting more expensive at a geometrically faster pace than other systems. Big problem.

-edit-

Not very confidence-inspiring: GOP Senate majority leader weighs in. "[H]e doesn’t favor comprehensive legislation to replace it. 'We would want to more modestly approach this with more incremental fixes,' he told me. 'Not a massive Republican alternative.' Two ideas McConnell mentions are allowing people to purchase health insurance across state lines and reforming medical-malpractice laws."

Those old chestnuts? That's the alternative?

[Strike For The South]

I think this is one of the most relevant criticisms of Obamacare (and Romneycare): yes, near-universal coverage is achieved, but no big steps are taken to rein in costs. And if you compare the year-over-year increases, our system is getting more expensive at a geometrically faster pace than other systems. Big problem.

Obamacare was rushed through and hamstrung by all the worst parts of the art of compromise. To tout what will become law in 2014 as universal health care is putting lipstick on a pig. The end result will most likely be higher rates, more red tape, and a crushing effect on small buisnesses. Obama gave up to much in order to get the thing passed, quite the phyrric victory.

As you allude to in the op a purley based market system may in fact be better but it is not a practical reality unless we accept the fact the uninsured will die becuase their is no saftey net for them. I do not mean to be hyperbolic but my larger point is the American people will not stand for a pure market becuase no one is going to turn away the uninsured at the ER (nor should they). Guess who ends up paying for that?

People wait until the last possible second for medical care percisely becuase they lack or have inadequte coverage. Then everyone ends up paying more becuase they waited so long to take care of their medical issues.

I would be remiss if I didn't mention that an NHS would require a tax hike. But that's a small hurdle compared to the elephant in the room. An NHS would eliminate allot of jobs. A price I am more than willing to bear, of course I don't work in health care.

[rory_20_uk]

A nice graph of comparative costs, courtesy of McKinsey.



Those will be some of the most well heeled lobbyists in the land, and faced with a potentially life or death struggle.

Perversely, in the UK the PM has a lot more power than the President does - as evidenced by the first challenges occurring 12 minutes after the bill was passed where here changes can be more effectively deployed (whether the changes themselves are effective is a different matter).

I did some work for a friend who was looking into getting involved in preventative medicine in the USA for Diabetes. In a cohort study of the staff of one company, the ROI was under 5 years - and this for a long term illness.

I really don't know how the USA is going to sort this out. Although oft said, it can't go on - spending 20, 30, 40 percent of GDP on healthcare is insane, but based on current trends is going to happen.

[econ21]

I did some work for a friend who was looking into getting involved in preventative medicine in the USA for Diabetes. In a cohort study of the staff of one company, the ROI was under 5 years - and this for a long term illness.

Rory, can you spell this out a bit? For example, what's a ROI? Can you explain this study and what you infer from your work in layman's terms? It sounds interesting.

[rory_20_uk]

Rory, can you spell this out a bit? For example, what's a ROI? Can you explain this study and what you infer from your work in layman's terms? It sounds interesting.

Link this is the document that I created. It was for internal review, and yes, is gleaned from others and there was no time to properly reference it. Rest assured it was all plagiarised from online sources.

ROI - Return On Investment - this was being prepared for the basis of starting a company, but savings are equally important if it was a non-profit.

[Rhyfelwyr]

What I like about the NHS is that not only does it provide a better value service than what people currently have in America, I think it strengthens British society.

From what I've seen the levels of care poor people get in America is shocking, it's bordering on third-world levels. Meanwhile the rich get the best of the best.

That doesn't happen in the UK. Rich or poor, most people will use the NHS (of course some will still go private). It's something we all have in common regardless of class, creed, colour etc.

This obviously means that there is less of a disconnect and less resentment between the rich and poor. If we are going to live together as a society then we have to have things in common. Shared institutions like the NHS, BBC, Royal Mail etc are all good examples of that.

No death panels. No communism. Just a decent level of health care for everyone.

Somtimes I wonder if the lack of these things in America is what makes politics so polarised there.

Of course the social, political, and even geographic make-up of the USA is completely different to that of Britain, so I can't presume that what works here will work there.

[Lemur]

Of course the social, political, and even geographic make-up of the USA is completely different to that of Britain, so I can't presume that what works here will work there.

Given that the USA is the only industrialized nation without some form of universal healthcare, I think that's a dodge. If it can work for a nations as racially and physically diverse as India and Singapore, it could work here. That's ignoring the baggage we bring to the table by having invested so much for so long in our jackalope hybrid system, however.

More legal analysis:

In weighing how the contemporary Supreme Court behaves, there’s a relevant precedent here. In the Citizens United case, the Supreme Court not only rejected a major piece of legislation but created a constitutional standard that makes any meaningful campaign-finance legislation next to impossible to pass.

The question is whether they will do the same with health-care reform.

[Strike For The South]

That's worrisome, to block the government from healthcare will only continue us down an untennable role.

Granted considering Uncle Sam already foots a large part of the bill I don't know how they would word it. Granted I don't put it past them either

[rory_20_uk]

Death panels? Oh, we are up with the Media Hype.

Until healthcare is infinite there will always be rationing. Who gets organs is decided by a panel of experts, and yes, those who don't get them have an increased chance of dying.

People are increasingly demanding of the NHS. A cough for 2 weeks - quick, off to the GP!

I am not advocating this as the "good old days" but one elderly patient informed me that pre-NHS, seeing the GP would be the pay for a day or so - not something taken lightly. I personally think that a nominal charge attending both A&E and one's GP. In France, people are expected to bring all their medical records to their doctor and this is considered normal, so I don't think paying a small payment isn't unreasonable, and would help preserve the system for the future.

[Graphic]

The goal should be Maximizing care while minimizing cost. The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I just want an NHS, Sorry for being fiscally respobsible

NHS vote from me too. Obama's health reform is fundamentally flawed because it goes out of its way to preserve the private system for no other reason than "just because." It has no point other than to perpetuate its existence, working around it or within its framework can't help but be inefficient and costly.

[a completely inoffensive name]

Whatever. My logic is flawed but it looks like this will be a win-win for me anyway. If it is upheld Obama wins, if it fails we are that much closer to single payer.

[CountArach]

The goal should be Maximizing care while minimizing cost. The individual mandate is a middle ground which keeps the bloat of the medical industry intact under the guise of "universial health care"

I just want an NHS, Sorry for being fiscally respobsible

That's pretty much the best summary I've seen of the individual mandate.

It is interesting to me that some of the people supporting an NHS-style system are also some of the people talking up Ron Paul in the nomination thread

[drone]

It is interesting to me that some of the people supporting an NHS-style system are also some of the people talking up Ron Paul in the nomination thread

A lot of us Ron Paul types support him for his libertarian social views. But there are just too many conflicts of interest with market based health care. When a person is seen as a customer instead of a patient, it's not going to end well.

That makes no sense how can it be legal to force people to buy/use this mandate at state level and if it's found to be illegal at federal level.

10th Amendment.

[gaelic cowboy]

Nice conjob there lads they can blame the federal gubmint for Obamacare and as a result harvest votes, then they can bring in Perrycare which ends up being the same anyway.

naturally the cost then most likely ends up becoming a federal one which they can also rail against as unfair taxes resulting in more votes.

I am intrigued by this tenth amendment if it's found illegal at federal is it not by definition something the federal government should proscribe at state level.

[drone]

I am intrigued by this tenth amendment if it's found illegal at federal is it not by definition something the federal government should proscribe at state level.

The Constitution is meant to outline the limits of federal power, the 10th amendment specifies this clearly. If the Constitution does not give a power to the feds, that power belongs to either the states or the people.

There are many ways the federal government has gotten around this, usually through a combination of the interstate commerce clause and the necessary and proper clause. Social Security is an example of this, and if we are going to be forced into national health care I'd prefer that to be the model we follow.

I would prefer a country without universal health care to one where the federal government can force me to buy stuff. Corporations are already helping themselves to the treasury, this would just cut out the middle man.