You can come to the US now, we have health care

[Ed Oscuro]

SCOTUS has ruled that the individual mandate of "Obamacare" is constitutional, with conservative Chief Justice Roberts providing the key vote.

No time to read much on the opinion, but it looks as if the string of Commerce Clause rulings remains unbroken. Interestingly, the Attorney General's case was that the individual mandate was not a tax, but SCOTUS ruled that it is constitutional as a tax. For once they're smarter than the guys presenting their cases.

Also, they struck down the Stolen Valor law - so if you want to lie about being a highly decorated Seal with 5000 congressional medals of honor, that's OK too, so long as you don't defraud anybody.

Between this and the Monday rulings (including the ruling striking down most of the onerous Arizona immigration law, and leaving the final portion open to a future challenge based on evidence of racial profiling) I'm starting to like this court.

Also, News Corp. is splitting into two companies. What was that line about Christmas in July? It's not even July yet.

[MX7]

And just as it's being well and truly dismantled in the UK Actually fairly tempting. What are the good bits of America, where people are left leaning, there are lots of woods, jobs for film studies lecturers and where people will think my accent is cute?

[FIL]

It's called Canada I think.

[rancor]

And just as it's being well and truly dismantled in the UK Actually fairly tempting. What are the good bits of America, where people are left leaning, there are lots of woods, jobs for film studies lecturers and where people will think my accent is cute?

Austin, Texas my man! We need you! We've got the University of Texas - one of the largest in the US - and it's in Travis county, which is a nature lovers dream. And the ladies are amazing! Not to mention that the UFO arcade is there which last I heard had an enviable STG collection! Just make sure that you like your summers HOT and sunny.

[Skykid]

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

[CMoon]

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

I'm waiting for the conservatives to tell us why this is a bad idea in 3...2...1...

[FIL]

Because poor people are all malingering wasters!

[MX7]

FUCK THE POOR

That's what it comes down to really, isn't it?

[Ed Oscuro]

The funny thing is that as they were announcing it I was writing a response to Allen E. Buchanan's article on the "right to a decent minimum of health care." Bizarrely, he thinks that there is no such right, basically because other things could conflict with it. He doesn't think people have a moral right to it. At the same time, he argues that "special rights" (like reparations for slavery) could provide such a right (which is a contractualist view, I think), prevention of harm (utilitarian), and prudence could fill this gap. I think it's much easier and that there is indeed a right to a minimum standard of health care. You could say it's a sort of fictional right that we agree upon, or that only technology makes it possible, but it's still something like a moral right.

Mainstream conservative commentators make it even easier. They either say that you do have a right to health care, but somehow Obama's health care would destroy this right (destroy village -> save it), or they agree that you don't have a right to anything you can't pay for. I think that gets the idea of "rights" wrong - clearly, if there is not enough oxygen in the room, I will fall unconscious and eventually die. Likewise, if you can't sustain the funding, we lose many things we like, such as defense or education (public or private, vouchers or home schooling, take your pick, they all will fail). But the "right" is something different, which assumes that we actually do have some room and don't have to be fatalistic about it, at least in the short term. It asks what you should do when you can do it. It is much cleaner for many mainstream conservatives to argue that health care and other "liberal" government expenditures always crowd out other expenditures, including all the fun things that we like and liberties like making hot dogs or roofing tiles at a private business, or even going to Church on Sundays. It is of course also wrong. They might allow that even if government spending doesn't crowd out other expenditures that it at least puts other expenditures at grave risk due to the slippery slope.

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

I'm waiting for the conservatives to tell us why this is a bad idea in 3...2...1...

There, done so they don't need to bother. Pre-refuted too.

[gabe]

Austin, Texas my man!

Good answer.

I was going to suggest one of the densely populated areas on either coast, but I might give Austin the nod based on cost of living.

Shit. I should really move to Austin.

[CMoon]

Shit. I should really move to Austin.

Too bad about the rest of the state surrounding it.

I'm not 100% satisfied with California, but I can go hiking in the mountains every day of the year. It counts for something.

[CloudyMusic]

And just as it's being well and truly dismantled in the UK Actually fairly tempting. What are the good bits of America, where people are left leaning, there are lots of woods, jobs for film studies lecturers and where people will think my accent is cute?

Sounds like you want the Pacific Northwest.

I miss the place dearly, but I'm stuck in its polar opposite, Arizona, at the moment.

[Ed Oscuro]

Interesting, right now I'm responding to something written by J. Budziszewski, professor of philosophy in Austin. If you need Christian apologetics and natural law studies, that's your place to go.

To be fair I kind of liked Austin when I was last there (or however close it was that I got).

[t0yrobo]

And just as it's being well and truly dismantled in the UK Actually fairly tempting. What are the good bits of America, where people are left leaning, there are lots of woods, jobs for film studies lecturers and where people will think my accent is cute?

Sounds like you want the Pacific Northwest.

I miss the place dearly, but I'm stuck in its polar opposite, Arizona, at the moment.

Sounds about right, I always hear good things about Washington/Oregon, or there's always Vancouver. And your accent will get you ass just about anywhere in the US.

[Acid King]

I've only read the syllabus, but so far I can't say I'm a fan of the reasoning in it. In order for SCOTUS to consider the constitutionality of the individual mandate, it can't be considered a tax, because a tax has to be levied before it can be challenged. Congress didn't intend for it to be a tax, so the court can go ahead and consider the mandate's constitutionality. When they consider constitutionality, they say it would be unconstitutional under the commerce clause and the necessary and proper clause because of the activity/inactivity dichotomy (you can't regulate inactivity) and because of the application of the necessary and proper clause speaks to granted powers. They find it constitutional under the power to collect taxes because, as precedent goes, the court has to consider a statutes most favorable interpretation when considering constitutionality, and the mandate can "reasonably" be considered a tax. This is despite having to consider it NOT a tax to even get to the point of interpreting its constitutionality. I don't know if I care to plow through it all but that seems to be the rationale.

I've never been a fan of the axiom that if it can be considered constitutional then it must be considered constitutional. To me that always seemed like it grants too much leeway to legislators, since it allows to legislate disingenuously. I think letting it stand under the commerce clause would have invited too much trouble, so they took the path of least resistance and accepted the tax interpretation.

I don't think anyone really cares what the reasoning behind the decision is though. Everyone has already made up their mind on the issue and the decision was bound to create a furor no matter which direction it took or how tightly reasoned it was.

[Ed Oscuro]

Responses from The Boston Globe including from the guy who helped Romney craft Romneycare.

Acid King, I'm not sure where I should begin. The government alleged it was not a tax, but SCOTUS obviously disagreed. Under the Commerce Clause, they called it constitutional.

The second part of your response is in line with a commonly held and cherished belief that SCOTUS is like Jesus or King Solomon and that their job is to only approve the good and disapprove the bad. That's not their job. It can't be, because even after Rawls, libertarianism, and the resurgence of natural law or virtue ethics, there is no theory of justice that gets it right all the time without complaint. SCOTUS's job is to judge whether something is constitutional or not. Whether or not it sounds like a tautology or low hanging fruit to you isn't the issue. If the Constitution said that black people must be enslaved, for SCOTUS to repeal that they would have to show it caused the Constitution to be internally inconsistent, for example (and that should be easy). If they could not (if we lived in some crazy world where the only part of the Constitution addressing rights stated that black people must be enslaved, for example), they would probably have to leave it to the legislature to fix it, or else cobble something totally new in terms of rights (which they might do, but courts view this as base activism and try not to invent new ethical theories, because even the existing ones in good repute are controversial in one case or another). So the SCOTUS has two goals - one, keep things that are inconsistent with the Constitution from getting around, and two, keep shit real. But if something is merely bad, but does not challenge other rights (which of course you might say rarely happens, since even the bluest of blue laws could be said to curb liberty), it's not really under their purview.

Take Sen. Scott Brown's response to the ruling - it may be Constitutional, but it's not "good," which sounds like he's saying "it's not the best of all possible worlds, why couldn't it be perfect like my dreams?"

As far as I'm aware, there is no theory of justice that says that "legislators are terrible, therefore we must rely on the cabal of nine to make up the minds of the people."

You say that legislators often legislate disingenuously, and while that is true, it is a wonderful fact that we have to assume that We The People must get things right, on balance, often enough or at least in important cases so that bad stuff doesn't happen, because God is not known to get involved in American politics directly (Bush 43 aside). The clear cases of rights being violated are, if not clear-cut, obvious enough that SCOTUS can intervene to deal with them and prevent a slide down the slippery slope.

[undamned]

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

I'm waiting for the conservatives to tell us why this is a bad idea in 3...2...1...

I think the main argument (and concern of mine) is quality of health care provided.
-ud

[antron]

The government alleged it was not a tax, but SCOTUS obviously disagreed. Under the Commerce Clause, they called it constitutional.

no, they actually found it unconstitutional under the Commerce Clause 4-5. But constitutional as a tax 5-4. Go figure.

and the governement only called it "not a tax" to the public, to the SC they argued it as a tax, as a plan B. and it worked.

[Obiwanshinobi]

Health care costs money indeed and if you can print money up to your heart's content, as it used to be common in the so called real socialistic countries, you can sweep the issue under the rug for quite a while, but you end up with the society standing in line for toilet paper ("tape of life" in fairy tale terms).

[Acid King]

I don't know where you're pulling some of this shit from, Ed, but c'mon, I know what the role of the court is and I'm not suggesting judges are like King Solomon or Jesus. All I suggested was that applying the precedent from Hooper, where the court accepts the one constitutional interpretation of a statute when there are conflicting interpretations, may be too deferential. Taking the opposite approach and always taking the negative view of a statute would be too far in the opposite direction. I wouldn't think it too controversial to suggest that the court consider the interpretations presented and weigh them against the legislative record and the expressed intent of the legislators. Also, where are you getting that the individual mandate was upheld under the commerce clause? I understand the four concurring opinions disagreed with that, but per the syllabus...

CHIEF JUSTICE ROBERTS concluded in Part III–A that the individual mandate is not a valid exercise of Congress’s power under the Commerce Clause and the Necessary and Proper Clause.

.....

The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle that the Federal Government is a government of limited andenumerated powers. The individual mandate thus cannot be sustained under Congress’s power to “regulate Commerce.”

Not to mention the media reports....

http://www.foxnews.com/politics/2012/06 ... -survives/

http://blogs.wsj.com/law/2012/06/28/hea ... ce-clause/

http://www.washingtonpost.com/blogs/the ... _blog.html

[antron]

So the Commerce Clause has been gutted, but why does it matter now? It seems congress can now make you do whatever it wants by hitting you with a big tax if you don't.

[brentsg]

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

I'm waiting for the conservatives to tell us why this is a bad idea in 3...2...1...

I think the main argument (and concern of mine) is quality of health care provided.
-ud

That would be my primary concern. My family had good health coverage for a fair (but expensive) price. We now have coverage that's much worse, but for the same price of the previous coverage. The employer that provides access to the coverage claims that this has happened due to the cost increases associated with compliance to the Obamacare legislation (extending coverage to "kids" up to the age of 26, pieces relating to coverage extended to folks with prior conditions, etc). This was plainly stated in a letter to all employees, so don't argue with me about it. I don't have access to any detailed information other than that. Basically they have to cover people that weren't covered before. These people are either "free" because they're now bundled in with the family plans, or they're people that didn't qualify in some manner before due to known health conditions. The end result was either going to be significant price increases or significant coverage decreases (or both).

So what are the options? Well we can either purchase crazy-priced coverage on our own, without the advantages of the group that she's in now. Or one of us can change otherwise lucrative jobs that we're happy with.

In addition to the degradation of services on paper, tons of hidden things have popped up as well. They are either the result of the medical field trying to re-gain lost revenues, or the insurance industry trying to reduce cost. Doctors are now finding new things to nickel and dime for.

A couple new recent examples:

-Family member has required a couple of medications for several years and there's no alternative. For one, insurance company has decide they will no longer pay for the needed dosage. However, they will pay for half the duration and double the dosage. Basically you have to take these tiny pills and cut them in half to achieve the prescribed dosage. It's pretty much impossible so now the family member takes some rough approximation of the prescribed dosage, due to crumbled pills and the fact that you cannot cut them exactly in half. This isn't something that should be forced with a medication that your life (or quality of life) depends on.

-Same family member, different medication.. Insurance company with now no longer refill any prescription before you have exhausted your supply of meds. You can't have like 2-3 days worth in hand and go get a refill, you have to wait till day 0. Head to the pharmacy to get the refill when family member is out of a very important medicine. Insurance company denies, saying they will no longer pay for this med. There's no alternative, so pay $361 for a one month supply. File appeal with the insurance co, because this has ALWAYS been covered before. Doctor has new policy.. since the insurance companies are forcing so many appeals for scripts, doctor now CHARGES patient to file appeal papers. Appeal takes most of a month, we win the appeal so it'll be covered next time and they state that it IS covered with our policy. However, if we want the $361 back then we must now file a second appeal and also pay the doctor to participate in a second as well. Even more infuriating, the doctor's stance is that we need to just pay out of pocket for meds and order then from Canada. A one month supply of the med we paid $361 for in the USA is $40 in Canada.

-Had a sick child just this past couple of weeks.. It's not a 911 type of emergency, but it's very urgent. Delaying treatment will simply increase risk of a very serious problem, and it will also result in a much more difficult treatment scenario down the road. So I called doctor after doctor.. nobody can/will see my child in a reasonable timeframe. Like I need an appointment in a day or two and I'm getting appointment slots in September and such. I can take the child to the ER.. which isn't really what it's intended for. After communicating with a friend in the industry, I'm advised to call the doctors again and offer to pay cash and completely remove the insurance company from the equation. Doing this, I can now get an appointment today or tomorrow. WTF???

This behavior is all relatively new and there are plenty of other examples as well. I realize that some of this is anecdotal but the timing sure is suspect. And what alternatives do we have? We can pay vastly more to get a good policy away from work. We can't afford this one. We can bend over and take the only option offered by the employer. We can change jobs in a difficult economy. This isn't a good idea because we sacrifice seniority (and therefore job security).

I've no doubt that there are people who will straight-up benefit from the legislation, because they didn't have coverage before. However, this will come at the expense of people who were already carrying the load. And the expense won't simply be financial, it'll be a combination of financial and physical health.

Edit: And yes, I realize that none of this has to do with the constitutional aspects. The piece of that I found so bothersome is that the President has repeatedly told the people "This is not a tax!", yet that's exactly how it was considered by the Court to get it upheld by the slimmest possible margin.

[Specineff]

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

I'm waiting for the conservatives to tell us why this is a bad idea in 3...2...1...

I think the main argument (and concern of mine) is quality of health care provided.
-ud

This. It's going to be sucky healthcare anyway, regardless of who provides it.

[Acid King]

So the Commerce Clause has been gutted, but why does it matter now? It seems congress can now make you do whatever it wants by hitting you with a big tax if you don't.

I don't think the commerce clause has been gutted. It doesn't seem like they put much of a restriction on it other than it can't be used to compel people to engage in economic activity. I don't think it's going to retroactively affect many programs and powers that have fallen under the commerce clause. it's not like they took a whack at Wickard or anything.

[Skykid]

I think the main argument (and concern of mine) is quality of health care provided.
-ud

This. It's going to be sucky healthcare anyway, regardless of who provides it.

Privatised healthcare is divisive and breeds cynicism between the classes. For wealthy people to get immediate attention and jump queues, poor people have to suffer. When it comes to the health of your population, the size of your income should not be an issue. It's possible to have public healthcare and still have private for those with the funds to buy into it.

Also, fuck Mitt Romney and the republicans, sick of seeing those assholes trash talk on my TV. I hope Obama gets re-elected. He may not be perfect, but at least he has a brain.

[Ex-Cyber]

I think all privatised healthcare should be abolished tbh.

Pay tax = get medical help. If Cuba can do it, anyone can.

I'm waiting for the conservatives to tell us why this is a bad idea in 3...2...1...

I think the main argument (and concern of mine) is quality of health care provided.
-ud

Also, moral hazard. If people don't have to risk paying medical bills and/or higher premiums, they will decide to be sick instead of deciding to be healthy. Or they'll more frequently decide to procure unnecessary medical treatment.

[neorichieb1971]

The only reason why America doesn't want it is because they have never tried it.

The other thing that baffles me is that the guy running against Obama wants to reverse this political movement straight away. If America is split 60/40 on the votes there are going to be a lot of extremist activities.

Ideally, US should be split in 2 with democrats running one half and Republicans running the other half. Then people can just choose what half they want to be in.

[rancor]

Coming from America to Japan, I've seen what free healthcare can do to a society and I don't see how it's sustainable. My wife, who is Japanese and grew up with this free healthcare goes to the hospital for anything that is even slightly wrong. Her reasoning is that it's free, so why not? Its really unbelievable some of the petty shit she goes in for. Cut her finger? To the hospital. Tummy-ache? To the hospital. Put her hand on a hot surface? To the hospital. I know she's not alone in this reasoning because the people at work ask me if I went to the hospital anytime that I call in sick - be it a slight cold or a mild case of food poisoning/diarreah. I'm the type of person that doesn't go in for medical care unless I'm squirting blood or body parts are bending in a way that they shouldn't. I imagine that we will soon see attitudes similar to my co-workers and wife take hold in America, especially since we're already an "all you can eat" culture. I have been to the hospital once in my 7 years here and it was for a broken arm. Treatment was fast and minimal.
While it's great that all will now receive healthcare in America, I don't see how the current quality of care can be maintained with so many people who will inevitably game the system.

[antron]

It's not free healthcare. It's fair insurance reform.

Any talk about cost reduction without understanding what a Accountable Care Organization (ACO) is, is a complete waste of time. It is a proven system in the US (Geisinger, Mayo, Kaiser). It's part of the law.

[neorichieb1971]

Coming from America to Japan, I've seen what free healthcare can do to a society and I don't see how it's sustainable. My wife, who is Japanese and grew up with this free healthcare goes to the hospital for anything that is even slightly wrong. Her reasoning is that it's free, so why not? Its really unbelievable some of the petty shit she goes in for. Cut her finger? To the hospital. Tummy-ache? To the hospital. Put her hand on a hot surface? To the hospital. I know she's not alone in this reasoning because the people at work ask me if I went to the hospital anytime that I call in sick - be it a slight cold or a mild case of food poisoning/diarreah. I'm the type of person that doesn't go in for medical care unless I'm squirting blood or body parts are bending in a way that they shouldn't. I imagine that we will soon see attitudes similar to my co-workers and wife take hold in America, especially since we're already an "all you can eat" culture. I have been to the hospital once in my 7 years here and it was for a broken arm. Treatment was fast and minimal.
While it's great that all will now receive healthcare in America, I don't see how the current quality of care can be maintained with so many people who will inevitably game the system.

I'm from the UK and i've never heard of anyone having it that bad. Most people in the UK go to the Dr for a dodgy sick note and thats it.

I don't think the UK service is that great. They give you pain killers and fob you off most of the time. I go to the Dr's if that has already failed, but not before. Common sense should prevail with a cut finger?