Remembering old arguments about this bill: the "fine" provision originated in the Senate, not the house, yet as I understand it, the Senate does not have taxing power.
Individuals who opposed O-care were deemed to not have standing; now that this is deemed a tax, won't we who end up complying have standing to challenge that the administration has arbitrarily administered the tax by granting the waivers?
So it appears that the Supreme Court today upheld the ACA in entirety today as constitutional. Barring legislative action to amend it, the law will be enacted over the coming years, though perhaps not exactly as envisioned. Despite the positive ruling, today's ruling has at least two important implications for health policy.
First, the ruling empowers states governments to take an active role in delaying or preventing implementation of the key provisions of the law. In particular, states now have the power to turn down additional Medicaid funding provided by the law and not risk losing existing Medicaid funds. Cash-strapped states will almost certainly consider this option since they will ultimately be on the hook for financing at least a portion of this expansion. Medicaid is supposed to cover 20 million of the 35 million people who will gain insurance under ACA. If enough states decide to deny the Medicaid expansion, this may substantially reduce the ability of ACA to expand insurance coverage.
Second, the court has ruled that the ACA can impose a tax on people who opt to not buy insurance, as opposed to requiring people to buy it. From a policy point of view, this is important because without the mandate (well, tax, I guess), the state health insurance exchanges have no chance of working. Without the mandate, it would have been possible for healthy people to not buy insurance until they became ill. Financing health insurance for the 15 million people who will gain insurance through the exchanges depends on more or less forcing relatively young and healthy to pay for the relatively older and unhealthy. The law, as envisioned, thus requires a large scale redistribution of money through this mechanism. There's still an open question of whether the penalty for not signing up for insurance is large enough to deter people from waiting until they are sick to sign up for insurance.
Overall, the ruling will make the implementation of the ACA a bit more difficult. While the federal government's role in health policy remains undiminished, the ruling places more power in the hands of the states.
1) It sounds like they can choose to uninsure or keep insurance on employees, is this an all or nothing choice for them?
2) Can they uninsure some and insure others? 3) Of the insured, can they opt out of being insured by work? 4) If so, would I recoup this portion of my total compensation? 5) With that money, I may or may not decide to insure myself? 6) If I don't, I pay a tax to the IRS?
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"We have resolution authority under Frank/Dodd... How about we USE IT?" Karl Denninger, 10/07/10 on the Dylan Ratigan Show, MSNBC.
2dogs
Posts: 2936
Incept: 2009-03-25
Land of the Lost
Steelpiston71 wrote..
would I recoup this portion of my total compensation?
ObamaCare screws every non-union worker out there. Obama of course gave union members waivered exemptions from the ObamaCare tax on the "cadillac" plans they have according to their union contracts. Employers will soon find it's more cost effective to cut off non-union workers' insurance plans and pay the penalty. Non-union workers lose their employer's health insurance, will NOT get compensated for that loss, and will also be on the hook for buying their own insurance.
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You can't defeat the combined effects of massive voter fraud, the Free **** Army, and the entire bought and paid for media complex. This nation is done.
Nationalized health care includes any universal system by which the Federal government sets and provides payment for health care. This includes systems that employee health workers directly and those that regulate the delivery of health care to the extent that costs are not determined primarily by market forces. Costs may always be reduced by limiting the amount of health care that is provided, and every nationalized health system established uses some form of rationing to minimize costs. The paradigm for government systems is that is appears cheap, but you can’t get much of it.
Here we are talking about the unit cost of delivered health care. If you manage to receive X amount of care, how much can we expect that to cost under a government system as opposed to a free market system. The reasons why costs will rise are:
1. Currently the fees paid by Medicare (the current government health care system for those over 65) are inadequate, so that individuals, private insurance, and local government ends up paying a disproportionately high fraction of the overhead costs of hospitals and physicians. When the private payers are eliminated, those costs will be realized in government costs.
2. Medicare, the model, pays only five or six percent in administrative fees compared to around eleven to thirteen percent for private insurers. The reason Medicare administrative costs are low is that they do not examine claims either for validity or fraud. There are provisions to report fraud, but only cases of large scale fraud are referred to the Justice Department. The Justice Department costs for investigation come out of the Justice Department’s budget and are not counted. Thus the costs of large-scale fraud detection are there, they are just not counted. The costs of undetected lesser fraud and of billing errors are borne by the system, but they are not identified as waste because they are not detected.
3. Bulk purchases of drugs do not lower the costs of the drugs. The costs of development and manufacturing are the same regardless of how the drugs end up at the patient’s bedside. Currently, R&D costs are borne disproportionately by private payers. If the government takes over all drug purchases, then all the development costs will be borne by the government, or, more likely, investment in new drugs will decrease because pharmaceutical companies cannot cover the R&D costs. New drugs cost about a billion dollars apiece to develop. With the likely result of fewer newer drugs, health care costs will rise substantially.
Drugs are cheaper in Canada because Americans pay the R&D costs. There are also some below market bulk buys by the Veteran’s Administration. So long as most drug purchases are paying the huge development costs, then manufacturers will sell incremental quantities so long as they are above the manufacturing cost. When the government sets the prices nationally, there is no one left to bear the development costs.
4. Nationalized health care destroys competition, thereby increasing costs. Some aspects of medicine, cosmetic surgery and laser eye correction, are firmly in the free market. Neither private nor government insurance pays for them. Costs in those areas half dropped by half, while other health care costs have risen sharply. This happened despite the desire to make profits. In fact, costs dropped because of the desire to make profits in the face of competition. That motivates an endless search for cost savings.
This is being seen in the current expansion of the “mini-clinic” industry in which small clinics are being built into drug stores to provide routine care, preventive medicine, and child health care at low fixed prices. the savings are achieved through high automation of routine services, with many services provided by nurses rather than physicians. Overhead is low.
5. Bureaucratic payment systems shift the emphasis from providing care to gaming the system. For example, Medicare pays by the office visit, so matters that could be handled in one or two visits are typically stretched into many visits. This is inconvenient for the patient and increases costs overall due to the decreased efficiency.
6. The claim is often made that a national system would increase preventive care, but it would not. A private health insurer tries very hard to make sure customers take their pills and get preventive care. Insurance companies know full well that lowers costs in the long run. A bureaucracy, however, only “succeeds” by expanding, and success within the system depends upon gaming the system. Neither motivator promotes preventive care. Preventive care would certainly be paid for by the government, but it wouldn’t be promoted. That’s evident in the Medicare system.
7. A national health care system will end up paying unskilled and low-skilled workers considerably more as a mechanism for politicians to buy their votes. That’s why government contracts often require that union wages be paid, and why government employees are the largest class of union workers. For example, the Postal Service pays 30% above market rates for labor, while FedEx and UPS pay slightly below the average rates.
8. There are two main reasons why health care costs are so high in the United States. One reason is that there is an elaborate and expensive emergency health system in the U.S. that is not paralleled in other countries. This is needed because of the very high incidence of traffic accidents, drug overdose, suicides, and criminal violence. There are also many heart attacks, which relates to the other cost factor: very poor lifestyles, characterized by obesity, poor diet, and lack of exercise. These cost factors are not treated at all by a national health care system. They are without question problems, and they may well deserve national programs, but they are social problems, not medical care problems.
Costa Rica has virtually no health care system, and costs are around $350 per year per person. U.S. costs are around $8000 per person. Yet the life expectancy in Costa Rica is only about three years less than in the United States. Clearly, the main cost driver is lifestyle, and a national system does not improve that.
9. About 16-17%, about 50 million, of the U.S. population is currently uninsured. The uninsured comprise about 15 million illegal aliens, 10 million who are eligible for Medicaid but haven’t applied because they are not sick, and about 5 million are people who can afford insurance but elect not to buy it (typically young self-employed people). Illegals should be given humane emergency care and then sent to be cared for by their home countries. That leaves about 7% of the population without health insurance. They mainly receive free health care through the emergency room system, and that is not an efficient way to deliver ordinary care. They could be covered by extending Federal aid to support Medicaid in poor states. That would improve efficiency without engendering the needless high costs of a nationalized health system.
10. Proponents of nationalized care claim that forcing doctors into large health centers would reduce costs. they claim that this would allow better utilization of expensive equipment. America has a very large rural population and has a critical dependence on emergency care. Replacing local care with a large center a hundred miles away would dramatically reduce the quality of care. Heart attacks and traffic accidents cannot be conveniently arranged to occur only near official centers. Reducing the care delivered by a large percentage to obtain a small percentage of administrative efficiency raises the unit costs.
11. Proponents claim that standardizing claim forms would lower costs. Non-uniformity of forms among insurers poses little problem because they all want about the same information, so the format is not a major cost item. However, if it could be shown that it saved a lot of money by always having the date in the same place, or whatever, that could be accomplished with a law far short of nationalizing health care.
12. The new government requirements for digital record keeping vastly increase the costs of record keeping. The government requires far more paperwork than any insurance company. The government is requiring that the vast amounts of information now kept in the doc’s filing cabinet, and mailed to the patient’s next physician, be laboriously digitized and stored on line. The government needs all that information so a bureaucrat can ration health care, deciding what you really need, and so government bureaucrats can second-guess the physician’s treatment remotely. It enhances the growth of multilayered bureaucracy while putting obstacles to prompt care. It also makes your medical history an open book to the government so you can be targeted for regrooving when they think it appropriate.
It is fundamental that increasing demand without increasing supply increases costs. It is also fundamental that nothing increases efficiency like the profit motive. Bureaucracy only “succeeds” by growing, further increasing costs. Winners in the system are those who game the system, not those who work efficiently.
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Success in life is a matter not so much of talent and opportunity as of concentration and perseverance.
Bezzle never offered an acceptable alternative to government.
Government is institutionalized violence and robbery. The alternative to institutionalized violence and robbery is to neither promote nor participate in them as acceptable for any reason whatsoever.
Cheapbastud wrote..
I need that image that Bezzle posted often with the dude on the hamster wheel that said "Vote like a mofo, petition the courts, Overruled!"
A question occurs to me: What is the penalty tax for someone with no income? If you didn't have to file in 2010 because you had 0 income, do you now have to file so that you can pay the fine?
Asimov
Posts: 103941
Incept: 2007-08-26
East Tennessee Eastern Time
Online
Hapa: There's a minimum income level where you simply don't have to file. I don't know what it is now, but a year or two ago it was ~$9800.
If you make under that, and don't file, there are no penalties.
[Edit: Scratch that, I didn't realize what thread I was posting in. I have no idea how they'll handle it.]
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It's justifiably immoral to deal morally with an immoral entity. If you trade based on what other people say, you will lose money. Especially what I say. I won't be held responsible. Festina lente.
I don't care if it makes sense -- only if it makes money. -- Me Bank (n): See scam, fraud and theft.Eat a bankster -- they're low-carb. What part of "shall not be infringed" was unclear?
Asimov
Posts: 103941
Incept: 2007-08-26
East Tennessee Eastern Time
Online
Reminds me of the marijuana stamp act.
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It's justifiably immoral to deal morally with an immoral entity. If you trade based on what other people say, you will lose money. Especially what I say. I won't be held responsible. Festina lente.
Fact 1: There Is No Law in the US Anymore Fact 2: Obamacare Is an Admission That All Previous Government Healthcare Programs Have Failed Fact 3: Cost of Already Doubled from Initial Estimates Fact 4: 70%+ of Healthcare Issues Results from Individual Choice Fact 5: The Inability to Discriminate on Pre-Existing Conditions is an Essential Driver of Healthcare Costs Fact 6: The Fines for Noncompliance Are Destined to Rise Enormously
Molyneux is smoking crack if he's under the assumption that "Law" is or was ever anything other than exactly like what happened today. Those who write laws have one over-riding purpose, before which any stated objective is of insignificant importance to them: to make you their subject, and thereby hold the truncheon of government initiated force over your head.
The Supreme Court exists to permit you the fleeting illusion that you have some say in a glacial way through the political appointment process. Because, well, if you didn't have that illusion, you might revolt.
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I was Bezzle's sock puppet before Tickerguy nailed my ass.
By allowing the states to opt out of the medicaid expansion, isn't this going to throw a massive money wrench into implementing the system? Won't poor people who qualify for the medicaid simply flee to other states and therefore flood the rolls?
Molyneux fell off the turnip truck yesterday of he thinks 5-4 decisions are unheard of or represent some unusual portent in American jurisprudence. (The "Welfare State" is three-quarters of a century old now, if you properly consider Social Security to be the initiation point -- yet to hear the gnashing of teeth, you'd think socialism only started this morning.)
The real "Fact #1" is that the phalanxes of lawyers and politicians and other categories of leeches in the ruling class make their hay off this kind of manufactured arbitrary divisiveness. Millions of obtuse laws are exactly what they prefer, because then you're forced to come groveling to them on your belly.
He flubs at the premise level in his assumption there was ever anything noble in law beyond the fanciful illusions of the governed.
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I was Bezzle's sock puppet before Tickerguy nailed my ass.
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