Originally Posted by herbal tee

Now that the individual mandate has been upheld we should look at what the cost will be--and who has to pay it.



Six percent of the population will be affected if the program is not repealed and the cost may amount to about 2k a year for a family of 4 or about $500 per person with the subsidy.

It is likely that the Republicans are going to try to pitch the mandate as the biggest tax of all time. In fact, I've heard blurbs along those lines already.
It will be a test of the voter education effectiveness of the Democrats to press the facts well enough that many poor citizens won't vote against their own self interest out of fear this November.

Yes, Obamacare as they call it isn't perfect, but it's the closest thing to a true fix that we're likely to see until the next 2T give us another social moment with its inherent openness to change and reform.

Karl Rove's SuperPAC is on the job:



That ad, by the way, is entirely accurate.

Meanwhile:

Gallup:

Americans See More Economic Harm Than Good in Health Law

But when is a tax not a tax?

When it can be both legally and conveniently avoided.

Next case.

what concerns me about this ruling is that Congress can now tax you if you fail to buy a product from a 3rd party private company. Even if you can't afford the product. Sounds like robbery to me. As Robert Reich pointed out in his blog, Congress can now pass a law forcing us to sign ourselves over to slavery, & then levy a tax on those of us who don't do so.

of course this POS law may still go down. This POS originated in the Senate. If it's essentially a tax bill it has to originate in the House, & it didn't. The House adopted it thru reconciliation, but it originated in the Senate.

the there's the matter of the purpose of a tax, which- at least up until this ruling- which is to raise monies to "promote the general welfare", (I believe is the wording) not to force people to buy stuff from private companies.

there will be other challenges. thus ain't over yet....

Originally Posted by sonrisa

what concerns me about this ruling is that Congress can now tax you if you fail to buy a product from a 3rd party private company. Even if you can't afford the product. Sounds like robbery to me. As Robert Reich pointed out in his blog, Congress can now pass a law forcing us to sign ourselves over to slavery, & then levy a tax on those of us who don't do so.

of course this POS law may still go down. This POS originated in the Senate. If it's essentially a tax bill it has to originate in the House, & it didn't. The House adopted it thru reconciliation, but it originated in the Senate.

the there's the matter of the purpose of a tax, which- at least up until this ruling- which is to raise monies to "promote the general welfare", (I believe is the wording) not to force people to buy stuff from private companies.

there will be other challenges. thus ain't over yet....

Do you own a car by any chance?

http://keithhennessey.com/2012/06/28/uninsured-tax/

...Oversimplifying a bit, for most people the tax in 2016 will be $750 per adult and $375 per kid. But while 21 million people will be uninsured, CBO said “the majority of them will not be subject to penalty.” That’s an understatement. You won’t have to pay the tax if:

you’re not in the U.S. legally;

you’re in prison;

you’re poor (measured two different ways);

you’re a member of an Indian tribe;

you’re in a period of being uninsured that’s less than three months long; ["you’re in a period of being uninsured that’s less than three months long" -now there's a loophole...]

your religion forbids getting health insurance; or

you get a waiver from HHS. Given HHS’ behavior in handing out waivers since the law was enacted, this waiver authority bears further observation and scrutiny.
In addition, some who are legally required to pay the tax will not do so. CBO/JCT therefore assumes a certain amount of noncompliance (aka cheating).

This gets CBO’s 21 million uninsured in 2016 down dramatically to 3.9 million who will be both uninsured and pay the tax. Total U.S. population in 2016 will be about 327 million. This means that, in 2016:

almost 94 out of every 100 people will have health insurance in some form;

five out of every 100 will be uninsured and pay no tax;

a bit more than one out of every 100 will be uninsured and pay a tax to the government...

Originally Posted by '58 Flat

Do you own a car by any chance?

-Health insurance is to protect YOU in case YOU get sick. It's an individual issue. Car insurance is designed to protect OTHERS in case YOU hit THEM. So, that would be a bad comparison.

As far as Obamacare goes, forcing a health insurance company to insure you with a pre-existing condition would be like forcing a car insurance company to except you after you've already had the accident.


FWIW:

Originally Posted by sonrisa

...there will be other challenges. thus ain't over yet....

http://online.wsj.com/article/SB1000...035021342.html

To push through key parts of the Affordable Care Act, Democrats used the 'reconciliation' process. A Republican president, House and Senate can use reconciliation to repeal them...

Originally Posted by JDG 66

-Health insurance is to protect YOU in case YOU get sick. It's an individual issue. Car insurance is designed to protect OTHERS in case YOU hit THEM. So, that would be a bad comparison.

As far as Obamacare goes, forcing a health insurance company to insure you with a pre-existing condition would be like forcing a car insurance company to except you after you've already had the accident.

Maybe a better analogy would be that Obamacare is like forcing auto insurance firms to accept you if you've been rear-ended by other vehicles, in a world where having someone plow into you when you are stopped at a red light can result in you losing coverage.

Originally Posted by sonrisa

what concerns me about this ruling is that Congress can now tax you if you fail to buy a product from a 3rd party private company. Even if you can't afford the product. Sounds like robbery to me. As Robert Reich pointed out in his blog, Congress can now pass a law forcing us to sign ourselves over to slavery, & then levy a tax on those of us who don't do so.

of course this POS law may still go down. This POS originated in the Senate. If it's essentially a tax bill it has to originate in the House, & it didn't. The House adopted it thru reconciliation, but it originated in the Senate.

the there's the matter of the purpose of a tax, which- at least up until this ruling- which is to raise monies to "promote the general welfare", (I believe is the wording) not to force people to buy stuff from private companies.

there will be other challenges. thus ain't over yet....

The mandate is based on the fact that health providers cannot turn someone away from emergency treatment, which can get pretty broad in interpretation and very likely to be highly expensive AND that everyone else who uses medical care pays for those people through higher prices.

This is call "free rider" and it is thief. You can't have a rational concern for the "thief" of the mandate unless you also have it for the free rider thief and an alternative to fix it.

I prefer giving people an "open season" to buy insurance and those who choose not to take the offer would not be allowed another open season for 5 years. That would not get rid of the free rider thief for they would still get emergency treatment, but I think more people would make more rational decision if they had their choice rather than a penalty. They're brains get clouded up when someone threatens their freedom fries.

Originally Posted by JDG 66

-Health insurance is to protect YOU in case YOU get sick. It's an individual issue. ...

No, it is not an individual issue when the uninsured can get mandated care from a care provider which drives up health care prices on all of the rest of us. It is "free rider thief."

One of the biggest ironies in all of this is that the mandate concept originated from the Right for this very reason - people should have to pay for other other peoples' benefits. You see that in every other issue such as Social Security and Medicare, the only difference here is that it became a part of Obama's approach.

It just goes to show that the Right doesn't hold to principles.

The biggest irony of all, of course, is their standard bearer, Mittens, was the most successful at getting such a mandate in place at least until Obamacare came along - and that is the real reason for their opposition.

An unintentionally hilarious pic:




I can't believe people can be THAT clueless...

Originally Posted by playwrite

The biggest irony of all, of course, is their standard bearer, Mittens, was the most successful at getting such a mandate in place at least until Obamacare came along - and that is the real reason for their opposition.

-- this is why I don't expect Mittens to repeal it. It's his idea, afterall

but my point is that this ruling can be used to force us to buy other stuff we don't need or cannot afford to benefit a 3rd party. What if Congress- to benefit the siding industry, say- mandated that everybody must have siding on their homes, whether you can afford it or not. Even if you have a brick house & don't need it. Even if you DO have a leaky roof, but have to get the siding instead or pay a tax. Because failure to get your house sided results in a tax. It's like the Bloomberg/soda pop thing in reverse, telling you waht you can & cannot buy

Originally Posted by sonrisa

-- this is why I don't expect Mittens to repeal it. It's his idea, afterall

but my point is that this ruling can be used to force us to buy other stuff we don't need or cannot afford to benefit a 3rd party. What if Congress- to benefit the siding industry, say- mandated that everybody must have siding on their homes, whether you can afford it or not. Even if you have a brick house & don't need it. Even if you DO have a leaky roof, but have to get the siding instead or pay a tax. Because failure to get your house sided results in a tax. It's like the Bloomberg/soda pop thing in reverse, telling you waht you can & cannot buy

While this article was about why states are likely to take up the Medicaid expansion, it also gives one a sense of the costs of "free riders" in our health system, i.e., those that have no insurance but are provided care that raises the prices of healthcare for everyone else -

http://www.washingtonpost.com/blogs/...aid-expansion/

The super wonky reason states may join the Medicaid expansion

Are you ready…to wonk? Good, because we’re treading into an obscure, acronym-laden area of Medicaid policy that does not usually get much attention, but plays a huge role in states’ deliberations over whether to join the health law’s Medicaid expansion.
It all centers on something called DSH payments (pronounced “dish” payments, in health-wonk parlance). That stands for Disproportionate Share Payments, extra money that Medicaid sends to hospitals that provide a higher level of uncompensated care. Those payments, which totaled $11.3 billion in 2011, are meant to offset the bills of the uninsured.

The Affordable Care Act phases out these payments. If most Americans are covered under the Affordable Care Act, after all, hospitals would presumably see a reduction in unpaid bills. They wouldn’t need the supplemental payments anymore.

That was the thinking before the Supreme Court decision, at least. If a state opts out of the Medicaid expansion and does not extend coverage to those living below the poverty line, the math changes. The unpaid bills do not disappear, but the DSH dollars do. Barring an act of Congress, those supplemental funds will be largely phased out by 2020.

That’s a big deal for hospitals, who already spend about $39.3 billion a year on uncompensated care, which makes up 5.8 percent of all expenses. Add on another $11 billion and hospitals would find themselves spending 27 percent more covering unpaid bills. It especially matters in states with more uninsured residents. In Texas, for example, the hospitals received $957 million in DSH payments last year.

That money goes away, regardless of whether Texas decides to join the Medicaid expansion or not. Those dollars could be replaced with new Medicaid payments – or, if not, it will be about a $1 billion in new bills for Texas hospitals to foot.

As noted, that over $11 billion in federal compensation to hospitals did not cover all the costs of the uninsured by those hospitals and it doesn't cover what other health providers have been doing for the uninsured - all of which increase the cost of healthcare for everyone else. More importantly, under the ACA, this federal reimbursement ends making, as noted in the article, the costs being more fully born by the the providers which eventually means all of us in the form of more costly services.

The tax is on those people that are pushing THEIR costs onto the rest of us.

Show me a good or service outside of health care where the govt mandates that it be provided and then compensates the providers. Then you might have a point about the possibility that the govt might tax free loaders getting those goods or services. But guess what: I'd probable be okay with that tax as well.

In the meantime, I think I'll worry more about the lose of gravity and us all floating off into space as a result of the end of the Mayan calender.

Originally Posted by JustPassingThru

That ad, by the way, is entirely accurate.

There is one misleading statement in the ad. It implies that the penalty goes up every year forever, it does not.
Beyond this, I'm not going to imply that the approach that was politically possible to pass in 2009-10 would be my preferred approach. I will only say that all in all it is somewhat of an improvement over the current system that we accidentally fell into during the full employment years of WWII.

Obamacare: Storm Coming

by Dr. Marc Siegel

The climate in my medical office is changing; my patients sense that a storm is coming. They are worried, and there is little I can do to reassure them. They are used to my office manager getting approvals for the CT scans, mammograms, PSAs, and MRIs I order, and they realize that many of these tests will no longer be covered by insuranceonce Obamacare’s committees — which look at so-called comparative-effectiveness research and review current guidelines — are through with them.

Last week, with the Fourth of July looming, I was able to get a quick CT scan to rule out appendicitis for one patient, and an ultrasound of the legs to quickly diagnose a blood clot for another. Tests like these — ordered solely on the basis of my medical intuition– may not be possible in a few years. Since in both cases the symptoms weren’t “textbook,” I would probably have had to appeal to some Kafkaesque committee, wasting precious time; in an extreme instance, this could even cost a patient his or her life.
...

My patients are smart, and they can see into the Obamacare future, but there are a few things they may not anticipate. First, I believe our newest technology is in jeopardy because it is made for targeted, super-specialized treatment. We have been leaving the age of one-size-fits-all solutions and entering the age of personalized genetic and immunological treatments for cancer and other chronic diseases. Not only are these treatments expensive, but they also won’t work with an insurance or government-run model of care, which cannot justify a big expense for a treatment for a small group of patients (known as an orphan drug). This problem already exists in the current health-care world (Avastin and other targeted treatments for cancer, as well as the latest surgical techniques, are not always covered), but it will only get worse with Obamacare, which has strained to throw the insurance blanket over more and more people.

Originally Posted by Odin

An unintentionally hilarious pic:




I can't believe people can be THAT clueless...

Maybe when they rely upon FoX Newspeak Channel for their information...

Comment from "Health Care for All" advocate Don McCanne.


Comment: It is outrageous that some governors are refusing to provide
coverage to low-income adults, even though the Affordable Care Act
authorizes the federal government to pay most of the costs of this
expansion in the Medicaid program. So what is the Obama administration
doing to be sure that these individuals become insured?

Many of these low-income adults who are not yet included in the state
Medicaid programs are so poor that they will qualify, under ACA, for an
exemption from the "individual responsibility provision" - the penalty or
"tax" that must be paid for not being insured. Thus they have the explicit
right to remain uninsured without being penalized for being so.

Others are still poor, but fall above the threshold for the exemption from
the individual responsibility provision. It is for this sector that the
administration is taking action. They are making the generous offer to
exercise their authority to provide exemptions for these additional
individuals from the penalty or tax that would otherwise be assessed for
not being covered by an extension of a Medicaid program that the governors
refuse to authorize, or for not purchasing a plan in an insurance exchange
that they can't possibly pay for even with the subsides provided (not to
mention that most of these very low-income adults were presumed under ACA
to be covered by Medicaid, thus the law seems to lack provisions for them
to be allowed to receive subsidies for purchase of plans in the exchanges).

Wow. The most needy population is being left out and all the administration
can do is to relieve them of the financial penalties they would owe for
being uninsured?

To be fair, this is not simply a response of an uncaring president and his
administration. They have an irreparably flawed health care financing
system with which to work. But the administration should be lambasted for
not just cooperating with but also for leading with the planning and
implementation of such an unmerciful system.

This system is beyond repair. We need to replace it with a humane,
equitable and efficient single payer national health program that would
take care of the health care needs of all of us.

from your mouth to god's ears.

don't hold your breath, however.

I don't think this POS will even be repealed. Boehner & Dittoheads can pass all the repeal laws they want so long as bam-bam's squatting in the WH to veto them. But will they pass a repeal bill for Prez Mittens to sign? I don't think so. Too much like a rock & a hard place

I agree with you that this whole business sux & we need single payor, but at least this crumb will not force a tax on folx unable to pay the health insurance thugs, I mean companies

Originally Posted by JustPassingThrough

Obamacare: Storm Coming

by Dr. Marc Siegel

From the article:

Obamacare caters to the worried well by allowing anyone to use the insurance, whether he or she is sick or not, with lower co-pays and deductibles and therefore no incentive against overuse. My patients also realize that I will be paid less for seeing them — first by Medicare and Medicaid, and then the private insurers will follow suit. Patients anticipate longer waits in my office and less time to spend with me. No one is asking me any more when I will change my office carpet or paint the peeling walls.

Why isn't it possible for doctors to learn to identify the "worried well" and avoid prescribing them unnecessary expensive treatment? The author assumes that the government effectiveness guidelines will force him to reduce the care that he provides to patients when he knows or strongly believes that such care is needed while at the same time providing no help in avoiding lawsuits for not providing care when he knows such care isn't needed.

Originally Posted by The Rani

Identifying them is relatively easy. Convincing them that they don't need the treatment or tests is another thing entirely.

From your post to somebody's ears. But there have been worried well who've gotten nostrums since forever. In the 19th century it was patent medicine with opiates. Now we have depression meds advertised on TV. "This will make you feel like your life doesn't suck!" My GP showed me an ad for Abilify that cracked him up.

ETA: But there is that ethical problem, whih must be very difficult.

Originally Posted by The Rani

Repeal Obamacare and legalize drugs. All of them, right down to zombifying bath salts.
Then everyone is happy. Or at least they feel like their lives don't suck.

We already have a legal drug that zombifies. It's called ethanol and available at the local grocery store. People who don't know that ethanol can do this, haven't taken it at the proper dosage.

and if you don't like the taste, use a mixer

Originally Posted by annla899

From your post to somebody's ears. But there have been worried well who've gotten nostrums since forever. In the 19th century it was patent medicine with opiates. Now we have depression meds advertised on TV. "This will make you feel like your life doesn't suck!" My GP showed me an ad for Abilify that cracked him up.

ETA: But there is that ethical problem, whih must be very difficult.

It is a huge problem. It used to be unethical on the part of a pharmaceutical company to do advertising directed at patients. Physicians? Sure. They need to know what is available and what the side-effects are. Patients who are suggestible and gullible? No. Seemingly anything goes in medical advertising.

For good reason medical degrees require long years of schooling followed by a tough internship. These are the the people who should stand in the way of some patient getting a feel-good pill or a pointless antibiotic. Some people aren't sophisticated enough to read the warnings of side-effects... such as "may cause liver damage". You do not want to mess with your liver.

Depression can have biochemical causes that only a medication can treat. physical cause that only surgery can treat, or origin in a messed-up early life that only psychoanalysis can address. But depression can come from living in a miserable place, hating one's job, or being in a miserable family life. Those things cannot be solved with a pill or surgery. I can't imagine being black in the Jim Crow South and not being depressed... the cure for that was political change.

Sometimes the appropriate prescription for certain downer moods is "Symphony #6 by Jean Sibelius"... or visiting an art gallery. Nobody needs see a physician for permission for either.

Originally Posted by Ragnarök_62

We already have a legal drug that zombifies. It's called ethanol and available at the local grocery store. People who don't know that ethanol can do this, haven't taken it at the proper dosage.

Unfortunately, inappropriate doses cause liver damage.

Originally Posted by pbrower2a

Unfortunately, inappropriate doses cause liver damage.

Why stop there ? I want the Rani to be happy. I made some semblense of one of those patient guides that other drugs come with.
Drug: Ethanol:
Molecular formula: C2H6O
Molecular weight: 46.07 g/mole:
--------------------------------
routes of administration:
oral,intramuscular,topical
---------------------------
Mode of action GABA-A receptor agonist
----------------------------------------
Elimination route : hepatic
----------------------------------------------------------------------------------------------------------------
Side effects: See diagram below:

Originally Posted by The Rani

Um, what? Are you implying that I'm an Alcoholic-American?

Shoot no. My meds (except for *niacin for cholesterol issues ) all have have a drug information guide that comes with them. Perhaps if ethanol products came with a drug information guide like the one I made, people would know how ethanol affects the body. Stuff like "just say no" and frying egg PSA's aren't really informative.

*Niacin is one of those other drugs that needs a drug information guide. The most important one is that your doctor should "prescribe it" and schedule routine liver tests. Niacin can also screw up your liver at therapeutic doses. That and the damned flushing I get. It's not very comfortable for 10 minutes. The other test should be of course lipid levels to see if niacin works for a particular patient. It's a wonder drug for me. It doubled my HDL about (50), it sent my triglycerides down to about 80, but left the LDL to around 180. Obviously, my HDL level really sucked. Some of the other side effects are too much uric acid and blood sugar abnormalities.

oh sweeeeeet... isn't that a B vitamin? I take B vitamins to keep my energy level up

lord if I wanted liver damage I'd just hit the bottle