Here's a new challenge being made to the ACA. Essentially what is being contested is the fact that it started as an unrelated resolution in the House that the Senate then erased completely and rewrote to be Obamacare. However, there is the Origination Clause in the Constitution that says that all revenue bills must originate in the House (although the Senate may amend such bills). The issue is whether a "shell bill" introduced by the House then completely wiped by the Senate and rewrote for an unrelated subject (as opposed to being merely "amended") is unconstitutional under that clause. Some on the right have debated using this as a second way of striking down the mandate since the ruling in June that upheld it as a tax (and thus falls under the scope of revenue bills), but now someone has put the test to practice. Of course the issue could be rendered moot if a new bill with the same content (but introduced by the House) passed, but that's unlikely to happen as long as Republicans control the chamber (we'd probably be more likely to see it become moot via repeal, which is likely next year if there's a GOP sweep of the Presidency and both chambers of Congress).

I wonder how the CBO came up with that figure. Wouldn't it have to include estimates of how many people will choose not to get health insurance?

Originally Posted by The Rani

Oopsie:

Tax penalty to hit nearly 6M uninsured people

Whoo-hoo!

The underlying estimate has moved from 4M to 6M but nearly everyone has always talked about it being less than 2% of the population which remains the case, and for a penalty that is not enforced unless you're getting a tax rebate (hint check your withholding).

Also, as noted in the article, 20% of those being penalized have incomes above $115K for a family of four. You would have to be as dumb as a brick to not have health insurance with a spouse and two kids making that kind of money. I say, let the Darwin Theory do its job and improve the gene pool!

Now the article does say that the remaining 4M are below the 5X poverty level but doesn't say how many are below the 4X level (around 90K for family of four) that would receive federal subsidies. Again, not getting health insurance that is moderately to heavily subsidized by the govt depending on income??? Darwin do your work and turn those Red states to Blue just a bit faster!

My guess is, just like under Romneycare in Mass., the number will come down considerable. Not because these folks missing a marble or two grow a finer brain, but they'll soon see the impact on the medical bills of those that present themselves to health providers as uninsured - free ridershiip is going bye-bye.

It's October 1, do you know what your hospital is doing today?

http://www.washingtonpost.com/blogs/...-starts-today/

For hospitals, health reform starts today


..for American hospitals, it means something quite different: October 1 is arguably the day that the health reform law changed the way they get paid for providing health care.

There are two big parts of the health reform law going into effect today. One penalizes hospitals if patients are re-admitted to the hospital within one month of a visit for a condition that should have been dealt with on the first trip. The other seeks to redistribute higher Medicare payments to the hospitals that are delivering better care.

Both are part of an effort to fundamentally transform the health-care system in the United States by moving it from a system that pays for value rather than volume. If efforts like these succeed, hospitals will become more concerned with delivering higher quality health care. If they don’t, health providers will continue to earn a living the way they have for decades: By earning a fee for every service they deliver.

....The independent Medicare Payment Advisory Commission estimates that 15.3 percent of hospital admissions result in a re-admission. In 2010 alone, this happened 1.9 million times at an estimated cost of $17.5 billion.

Until now, there weren’t much in the way of penalties for a patient landing back in the hospital. There was actually a financial incentive for readmitting a patient, as that would mean delivering more health care that they could bill for.


....In Northern Virginia, the Inova health system has spent $2.4 million to hire eight health coaches and four case managers to coordinate and keep track of patients after discharge, said Vera Dvorak, vice president for transitional care. The company also opened two special clinics where doctors see Inova patients who can’t get appointments with their regular providers within a week after discharge. Inova’s five hospitals will get paid about $250,000 less from Medicare this coming year because of the penalties, officials said.

Even hospitals that were not penalized have taken steps.

Virginia Hospital Center opened a pharmacy on its campus and launched its own home health service. The penalty, said Robin Norman, chief financial officer, “is enough to have every hospital’s attention.”
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Now let's hear it from the chorus that the ACA had nothing to do with getting health costs down...


Ah, ah, ah....

Cue the crickets!

Originally Posted by playwrite

It's October 1, do you know what your hospital is doing today?

http://www.washingtonpost.com/blogs/...-starts-today/




Now let's hear it from the chorus that the ACA had nothing to do with getting health costs down...


Ah, ah, ah....

Cue the crickets!

This is not as clear cut as it sounds. Many do not understand how this penalizes hospitals and patients. This is kin to keeping already struggling non-for-profit hospitals to saying *teachers* are responsible for a kids grades, then docking their pay if their students aren't measuring up.

What happens when doctors, at the cost of a patient's health, refuses to readmit because of fear of the hospital losing money? One of the best hospitals in America is in our state. They also get some of the sickest patients because they are known for outstanding care and research. They also get many heart, kidney, lung and liver patients that receive transplants. These are some of the sickest patients a hospital might get. Yet they will get penalized if there are readmits, which are common, among the most ill. Fair? Not in the least!

Originally Posted by The Rani

They will either keep patients longer during the first admission (increasing costs) or refuse to readmit them (decreasing level of care.)
Either way is no cause for celebration, and what will actually happen is probably BOTH.

ETA:
But I actually think that's ok. Obamacare will result in the destruction of Healthcare as we know it, clearing the path for a new and better system to come along.
We'll have to wait a while for it, though. It's a good time to be healthy.

Yawn. Ho-hum, another thing to wait for...

Hyperinflation just around the corner. Watermelons replacing the Rose Garden. Mayan calender. Death panels. ect. ect.

I kind of lost interest in such craziness when that space ship that was suppose to come behind the Hale-Bopp Comet didn't show up. At least those folks had enough self-respect to take themselves out of the human gene pool.

Originally Posted by playwrite

Yawn. Ho-hum, another thing to wait for...

Hyperinflation just around the corner. Watermelons replacing the Rose Garden. Mayan calender. Death panels. ect. ect.

I kind of lost interest in such craziness when that space ship that was suppose to come behind the Hale-Bopp Comet didn't show up. At least those folks had enough self-respect to take themselves out of the human gene pool.

Oh yah, but if we didn't bail out your banking buddies down at TooBigToFail Inc, that would have been chaos and the total destruction of the global economy.

Or if we didn't invade Iraq, terrorists would blow up cities with nukes?

Right?

Wonder where people come up with this nonsense...

Originally Posted by JohnMc82

Oh yah, but if we didn't bail out your banking buddies down at TooBigToFail Inc, that would have been chaos and the total destruction of the global economy.

Or if we didn't invade Iraq, terrorists would blow up cities with nukes?

Right?

Wonder where people come up with this nonsense...

On the first, yea, probably.

On the second, no, that probably increased the chances.

You see, it's called discernment. The ability to discern from what are real concerns that have to be dealt with from what is utter bullshit and then all the shades of grey in-between.

It seems to be a skill that comes to folks the further from adolescence that they find themselves. Of course, some get caught in perpetual adolescence and the skill never seems to catch on with them. One dead giveaway is an Ayn Rand book tuck under their arm.

p.s. most of the bailouts have been paid back with profits to the US Treasury.

http://www.bloomberg.com/news/2012-0...uts-stake.html

AIG Stock Sale Repays Bailout as U.S. Government Profits

Another doom-and-gloom prophecy bites the dust.

Do you all ever get tired of being wrong?

Originally Posted by playwrite

On the first, yea, probably.

On the second, no, that probably increased the chances.

You see, it's called discernment. The ability to discern from what are real concerns that have to be dealt with from what is utter bullshit and then all the shades of grey in-between.

It seems to be a skill that comes to folks the further from adolescence that they find themselves. Of course, some get caught in perpetual adolescence and the skill never seems to catch on with them. One dead giveaway is an Ayn Rand book tuck under their arm.

p.s. most of the bailouts have been paid back with profits to the US Treasury.

http://www.bloomberg.com/news/2012-0...uts-stake.html



Another doom-and-gloom prophecy bites the dust.

Do you all ever get tired of being wrong?

Oh man, that is a pretty narrow definition if you're just looking at TARP.

I suppose you can't see what has happened to prices and you can't see the true opportunity cost created by giving the big institutions so much power during a crisis. That's ok, here's a CPI pacifier, just don't look pass the headline number... Stocks are good, right? That must mean everything is going great!

"We had too! I'm so old and entrenched in this system's way of thinking that I carefully discerned that any deviation from my interests would totally destroy the economy - everywhere! But anyone who points out problems with government actions is a fearmongering idiot!"

Yawn

Originally Posted by The Rani

...It will happen so slowly that people won't even notice....

-- so this disaster that you speak of "people won't even notice." WTF?????

How convenient for you.

At least the Hale-Bopp put it all out there - either da space ship or da old plastic bag over da head routine.

Originally Posted by JohnMc82

Oh man, that is a pretty narrow definition if you're just looking at TARP.

I suppose you can't see what has happened to prices and you can't see the true opportunity cost created by giving the big institutions so much power during a crisis. That's ok, here's a CPI pacifier, just don't look pass the headline number... Stocks are good, right? That must mean everything is going great!

"We had too! I'm so old and entrenched in this system's way of thinking that I carefully discerned that any deviation from my interests would totally destroy the economy - everywhere! But anyone who points out problems with government actions is a fearmongering idiot!"

Yawn

First, I would have really enjoyed a lot of perp walks, breakup of the banks and a whole host of regs far beyond what we got. While we didn't get anywhere near that, I still prefer where we are today than having you, me and everyone else we know still being in soup lines. You're like the guy suing the city because when the firemen saved your family from an inferno they got mud on your carpets.

Second, you need to hit the old econ books and learn the difference between cost-push inflation and demand-pull inflation. When you've got that discernment under your belt, get back to me and maybe we can have an adult discussion about the economy - otherwise go join your friends over at the Mises playground - I hear they installed some new magic ponies over there.

Originally Posted by The Rani

WTF is you need to put on your reading glasses again.
I didn't speak of a "disaster." I spoke about what it will take to get to a new and better system.

Increasing costs while decreasing care is not a disaster???

Yep, you definitely are one of today's dedicated health providers.

Pay-for-performance schemes may do more harm than good by changing the mindset required for good doctoring, experts say

Dan Ariely, James B. Duke Professor of Psychology and Behavioral Economics at Duke University, co-author of the editorial and the author of numerous research studies and three bestselling books on behavioral economics, including “The (Honest) Truth about Dishonesty,” said: “Several studies show that while performance-based rewards can increase output for straightforward manual tasks, they can undermine motivation and actually worsen performance on complex cognitive tasks, such as those required in medicine. The unintended consequence is likely a worsening of care, not its improvement.”

Lead author Dr. Steffie Woolhandler, also a professor at CUNY’s School of Public Health, noted another hazard: Some physicians in safety-net hospitals may score poorly because of circumstances beyond their control, such as their institution’s financial distress. “In such situations, penalizing low-scorers can make matters worse, effectively punishing patients who have nowhere else to go,” she said.

We certainly don't need anything that will interfere with good doctoring.

The editorial concludes, “We worry that P4P may simply not work because it changes the mindset for good doctoring.

http://www.pnhp.org/news/2012/august...-bmj-editorial

Originally Posted by playwrite

Second, you need to hit the old econ books and learn the difference between cost-push inflation and demand-pull inflation. When you've got that discernment under your belt, get back to me and maybe we can have an adult discussion about the economy - otherwise go join your friends over at the Mises playground - I hear they installed some new magic ponies over there.

Shall I remind you that my degree is in Political Economy, or should I remind you of the third type of inflation that the old books think they can ignore?

How about putting the old books back in the dustbin of history and cracking open some of the new research? This might be a good starting point for ya.

The old books are good if we're talking about religion or "faith" in systems. But when it comes to science, the new books are always better.

Originally Posted by JohnMc82

Shall I remind you that my degree is in Political Economy, or should I remind you of the third type of inflation that the old books think they can ignore?

How about putting the old books back in the dustbin of history and cracking open some of the new research? This might be a good starting point for ya.

The old books are good if we're talking about religion or "faith" in systems. But when it comes to science, the new books are always better.

Assuming that new is always better than old hasbeen disproven over and over again. The fact is, correct is always better, regardless. As long as the Billion Prices Project is out there as a sanity check, I'll trust the indices that correleate well with that.

In a battle between theory and empirical data, empirical data wins every time.

Originally Posted by JohnMc82

Oh yah, but if we didn't bail out your banking buddies down at TooBigToFail Inc, that would have been chaos and the total destruction of the global economy.

Or if we didn't invade Iraq, terrorists would blow up cities with nukes?

Right?

likely, yes.

and no.

in that order.

Originally Posted by The Rani

This one won't be like a terrorist attack or a stock market crash. It will happen so slowly that people won't even notice, other than those affected by it.
Which, of course, won't be the idiots in congress.

i. am. so. scared.

not.

Originally Posted by playwrite

Do you all ever get tired of being wrong?

but, playwrite, they do it with such sty---oh, i guess in their case, it's called snark.

Originally Posted by The Rani

WTF is you need to put on your reading glasses again.
I didn't speak of a "disaster." I spoke about what it will take to get to a new and better system.

uh-huh. you spoke of "this one" in comparison to a terrorist attack and a financial crisis.

what is "this one" if not a crisis?

Originally Posted by Marx & Lennon

Assuming that new is always better than old hasbeen disproven over and over again. The fact is, correct is always better, regardless. As long as the Billion Prices Project is out there as a sanity check, I'll trust the indices that correleate well with that.

In a battle between theory and empirical data, empirical data wins every time.

Oh god, we've been over this before, haven't we?

What does an average number tell us? Not much. Like the CPI headline number, it is reassuring but rather meaningless if we want to understand what is really happening.

Sure, prices are being cut left and right at car dealerships, Best Buy, and resorts around the country, but that is only because massive increases in costs of food, energy, education, and healthcare have drained anything resembling a discretionary budget from most households.

Is new better than old? In science, it typically is, because it actually observes all of the new data. The old books say that monetary policy is a small factor in commodity prices compared to supply and demand. The new research suggests this "conventional wisdom" is part of why we're stuck in this weak economic cycle.

Let's look at the auto manufacturer's point of view:

Sluggish demand causes price cuts and financing deals. Federal Reserve responds with stimulus that only effectively increases the cost of steel and aluminum. Customer has less to spend due to "stimulus" effects on food and energy. Demand falls, manufacturer must cut costs again, jobs are lost.

Repeat vicious cycle until food riots break out in some poorer country/neighborhood. Tell starving people there is no inflation because plasma TVs have never been sharper, bigger, or cheaper.

Originally Posted by The Rani

Actually, I said that it WON'T be like a terrorist attack or a financial crisis.
That's called "contrast," not "comparison."

yes. correction noted.

but you also wrote, "Obamacare will result in the destruction of Healthcare as we know it."

"destruction" is a traumatic event, a disaster, a crisis -- even if something better might come out on the other side, there is a high potential for damage in the meantime.

and saying things like this:

"It's a good time to be healthy."

makes you look callous.

it's *always* a good time to be healthy. may we all be healthy indeed. but if our "healthy" selves get hit by a car, we need care.

Originally Posted by The Rani

Well gee, sorry to have offended your delicate sensibilities.
I'm not the one voting for the guy who gave us this piece of crap legislation.

not my delicate sensibilities, rather my sense of decency.

what you said above was callous and inconsiderate.

i don't need snarky, insincere "apologies."

and i disagree that obamacare is a "piece of crap." so far it's an improvement over what we had previously.

Originally Posted by The Rani

You got nothing to worry about then, Miss Manners.

but it isn't all about me. it's about the welfare of the entire country.

hell, the entire world.

and that *does* concern me.

Originally Posted by The Rani

So what?

because it's the only home we've got. and we're all we've got. so we need to start caring about what happens to each other.

You're right, and I'm snarky and callous.
Obamacare will save us all ... as I said, you've got nothing to worry about.

how do you feel when you write these things?

Originally Posted by The Rani

I feel horrible. I'm a terrible person.
Is that what you want to hear? Are you trying to save me?

more insincerity.

but i expected it. you seem to have little capacity for empathy. so you resort to snark.

edit: but what's *really* fascinating about you is that you go back and delete many of your posts after a while.

perhaps that demonstrates some shame after all.