Obamacare and the Supreme Court

[ERCougar]

Budget cuts.

Well, thats sort of a government inaction, isnt it?

But...i guess I should be against those too. Whats to stop the government from ceasing to exist completely???

[All-American]

Well, thats sort of a government inaction, isnt it?

But...i guess I should be against those too. Whats to stop the government from ceasing to exist completely???

You tell me, then: what government activity, once engaged, is less easy to expand than to retract? And why is that not an argument for the utmost of caution in further expanding the scope of government activity?

[Joe Public]

People without insurance are never going to be denied emergency care when they are dying. It's immoral for the libertarians to even contemplate that as part of the solution.

Isn't that the reason hospitals are subsidized through tax exemption? I don't know how the actual numbers come out in that regard; you probably have a much better feel for how that plays out in reality.

I'm not sure how you feel, but I don't like government interference in my life.

Do you call the police if you're being robbed? Do you call the fire department if your house is on fire?

I obviously can't argue law with you

Two words: "corporate formalities."

[ERCougar]

You tell me, then: what government activity, once engaged, is less easy to expand than to retract? And why is that not an argument for the utmost of caution in further expanding the scope of government activity?

Sure, most entities, government included, are not in the business of making themselves irrelevant or working themselves out of existence. I'd therefore agree that we should be cautious about expanding government power, but I'd hardly argue that there aren't any checks on that power. Let's just address the specific issue at hand, and leave the fearmongering about hypotheticals for another day. If DC were to consider reversing the ban on handguns, it would be a silly and irrelevant argument to equate that to giving everyone assault rifles.

[CardiacCoug]

Isn't that the reason hospitals are subsidized through tax exemption? I don't know how the actual numbers come out in that regard; you probably have a much better feel for how that plays out in reality.

I'm just saying that the reality is that NOBODY can "opt out" of the health care system today. That's just the way our society works. It's a federal law that hospitals can't turn away people with medical emergencies because they can't pay and nobody wants to change that law (thank goodness).

So while my individual politics tend toward the Republican or even Libertarian end of the spectrum, I disagree with the idea that a health insurance mandate is overreaching by the federal or state government. When these anti-government, anti-insurance mandate Libertarians without medical insurance have a heart attack, they come to the ER, they get $100K of care, and they can't pay for it. That's the reality.

[doctorcoug]

People without insurance are never going to be denied emergency care when they are dying. It's immoral for the libertarians to even contemplate that as part of the solution.

I think it is pretty clear that we either need a market-based system with health insurance used only for catastrophic problems or a single government payer system. I have no problem with an individual mandate because the fact is that anybody could have a heart attack at any moment and it will be treated regardless of their insurance status. So a mandate seems fair.

I do feel that I have a moral obligation to care for the dying patient, regardless of ability to pay. A problem with this, however, is that it is a hidden tax. Those that pay for health insurance have higher premiums because of this law. I still feel we should do it.

The big issue I have with EMTALA is simply explained. I ran into one of my family's at the local hardware store. The mother asked me about a rash that her daughter has had for the last week or so. I gave my opinion and the mother was so thankful because "I was going to go to the ER later today". Never mind that I've explained our after hours call system a dozen times to her. Never mind that I gave her my own cell phone number. The ER is just so much easier when it is free.

EMTALA needs to have its scope cut back.

[ERCougar]

I do feel that I have a moral obligation to care for the dying patient, regardless of ability to pay. A problem with this, however, is that it is a hidden tax. Those that pay for health insurance have higher premiums because of this law. I still feel we should do it.

The big issue I have with EMTALA is simply explained. I ran into one of my family's at the local hardware store. The mother asked me about a rash that her daughter has had for the last week or so. I gave my opinion and the mother was so thankful because "I was going to go to the ER later today". Never mind that I've explained our after hours call system a dozen times to her. Never mind that I gave her my own cell phone number. The ER is just so much easier when it is free.

EMTALA needs to have its scope cut back.

Cut back to what?
I'm more negatively impacted by EMTALA than anyone, and I'm surrounded by people who complain about it, but when you ask them for a better alternative, you mostly get silence.

[All-American]

Sure, most entities, government included, are not in the business of making themselves irrelevant or working themselves out of existence. I'd therefore agree that we should be cautious about expanding government power, but I'd hardly argue that there aren't any checks on that power. Let's just address the specific issue at hand, and leave the fearmongering about hypotheticals for another day. If DC were to consider reversing the ban on handguns, it would be a silly and irrelevant argument to equate that to giving everyone assault rifles.

With respect, the interpretation of the commerce clause IS the specific issue at hand.

[doctorcoug]

Cut back to what?
I'm more negatively impacted by EMTALA than anyone, and I'm surrounded by people who complain about it, but when you ask them for a better alternative, you mostly get silence.

It is a combination. I think when this law was drafted lawmakers wanted to avoid patients having an MI being shown the door because they can't pay. The problem that the lawmakers didn't think about is "what is an emergency condition" and "how do we decide this is an emergency condition"? Because of this, otitis media is now an emergency condition.

Let's look at just Medicaid patients. It should be run like an HMO; if you go to the ER without having spoken with your doctor and it is deemed that you don't have a medical emergency, then charge a fee. If they don't pay that fee, then they lose benefits.

Next element, lets look at the hospital side. The ER might utilize a midlevel to triage. If the patient is delinquent on payments, then the midlevel triages and if an emergency then the patient moves on to see the doctor. If not, then the patient is told that they will not be receiving services at the hospital that day unless they bring their bill to date.

Regardless, all patients who are delinquent with their balance will be referred to an FQHC instead of the round robin no-doc call that we currently use and the associated one visit rule. This type of call results in many patients not having a doctor, thus utilizing the ER more.

Obviously this assumes that the midlevel has the ability to triage.

Another element is from the PCP. The PCMH initiative requires the clinic to have open access scheduling. I know many PCPs that are booked full and send their patients to the ER during the day. This shouldn't be happening. If we all work collegially and take care of the patient, everybody wins.

[Mormon Red Death]

I'm not as versed on the legal ramifications of the mandate but there are other reasons why we should be against the mandate.

The chief reason for me at least is that the mandate will make premiums increase. When everyone is forced to purchase insurance it the price of insurance will go up. This will in turn increase actual health care costs.

If the mandate's goal is to decrease costs then ironically it will do just the opposite.

[doctorcoug]

I'm not as versed on the legal ramifications of the mandate but there are other reasons why we should be against the mandate.

The chief reason for me at least is that the mandate will make premiums increase. When everyone is forced to purchase insurance it the price of insurance will go up. This will in turn increase actual health care costs.

If the mandate's goal is to decrease costs then ironically it will do just the opposite.

I don't understand why people don't get this. Even worse is when they can't charge women different from men nor can they exclude pre-existing conditions.

Somebody has to pay for these expensive patients and it isn't going to be the shareholders.

[All-American]

I don't understand why people don't get this. Even worse is when they can't charge women different from men nor can they exclude pre-existing conditions.

Somebody has to pay for these expensive patients and it isn't going to be the shareholders.

See, I can see why mandating young, healthy people who are much less likely to need health care to buy insurance anyway might reduce costs. I doubt that the relatively light penalty they have in place will actually drive people to purchase, though, and the money generated through the penalty won't likely be enough to offset the increase in prices.

Also, if the penalty can be shown as necessary to counterbalance the increase in prices that will result from forcible inclusion of those with pre-existing conditions, that may affect the Act's severability. Finding the mandate unconstitutional would then render the Act's other provisions void.

[Mormon Red Death]

See, I can see why mandating young, healthy people who are much less likely to need health care to buy insurance anyway might reduce costs. I doubt that the relatively light penalty they have in place will actually drive people to purchase, though, and the money generated through the penalty won't likely be enough to offset the increase in prices.

Also, if the penalty can be shown as necessary to counterbalance the increase in prices that will result from forcible inclusion of those with pre-existing conditions, that may affect the Act's severability. Finding the mandate unconstitutional would then render the Act's other provisions void.

Once young healthy people get insurance they will be like the rest of us and use that insurance. things they have put off. You know the shoulder injury you got from you last HS football game. well you are forced to buy insurance so why not have them do that surgery now that a big amount of that cost is gone.

[Moliere]

Once young healthy people get insurance they will be like the rest of us and use that insurance. things they have put off. You know the shoulder injury you got from you last HS football game. well you are forced to buy insurance so why not have them do that surgery now that a big amount of that cost is gone.

Which is way having high deductible plans (maybe $5K) would be a good idea. That unnecessary shoulder surgery will now cost you at least $5K. We need to get away from prepaid healthcare and get into health insurance again. Health insurance has become like income taxes in that some people are so far removed from the actual payments that their perception of the cost is skewed.

[Mormon Red Death]

Which is way having high deductible plans (maybe $5K) would be a good idea. That unnecessary shoulder surgery will now cost you at least $5K. We need to get away from prepaid healthcare and get into health insurance again. Health insurance has become like income taxes in that some people are so far removed from the actual payments that their perception of the cost is skewed.

I should have put insurance in " " as I feel the same way as you.