SCOTUS upholds Affordable Care Act

Supreme Court 2010

Back row (left to right): Sonia Sotomayor, Stephen G. Breyer, Samuel A. Alito, and Elena Kagan. Front row (left to right): Clarence Thomas, Antonin Scalia, Chief Justice John Roberts, Anthony Kennedy, and Ruth Bader Ginsburg

In a 5-4 decision today, the Supreme Court has upheld the Affordable Care Act, including its controversial individual mandate. No doubt days and weeks will now be dedicated to discussion and analysis of the decision and what it means to the uninsured, the insured, the states, employers, doctors, insurance companies, and of course, politicians.

Surprisingly though, the Court did not uphold the mandate under the Commerce Clause (opponents and yours truly had contended the government cannot require people to buy a product), but instead upheld the mandate’s penalty as a tax. What this means is anyone’s guess, and without doubt, everyone in politics and the media will be subjecting us to their guesses. Me, I’m puzzled. I didn’t see the tax thing coming and I have no idea what the ramifications of that might be.

The political posturing on the Affordable Care Act is about to get a lot worse, but informed citizens will read the decision and decide for themselves what it means. Here is a PDF file of the U.S. Supreme Court decision issued today.

Personally, I still don’t see what good it does to provide or require insurance for everyone when the health care delivery system itself is broken. It does no good to have health insurance if there are not enough doctors, nurses, and facilities to provide health care.

_

Previously on Pied Type:
But where are the doctors?
Health care reform: Mass fail
Do it right the first time



Categories: Constitution, health care reform / Obamacare, Law, Supreme Court

28 replies

  1. Well done PT, especially that last bit. As badly broken as the legislation is though, I’m still glad that Obama rather than Romney will be seen as the “winner” here. As for the taxes issue, that one surprised me also, but I guess it makes sense to renew the coffers from which the bills of the uninsured are paid by taxing them a little extra. I still have questions about how that’ll work out though.

    The libertarians have an interesting take on all of this. Check out what they sent to my email: Supreme Court Obamacare Decision Highlights Why a President Romney Would be More Dangerous than President Obama.

    • From your linked source: “… almost all elected Republicans and Democrats are Big Government politicians – in all things – including health care.” I hadn’t thought about it quite that way before, but it’s true. If you’re an elected official in Washington, you’re already a part of Big Government (aka Washington).

      It’s going to be interesting watching Romney try to attack something that (a) he did in Massachusetts and (b) the Supreme Court has upheld. He’d might be better off just finding another issue (if he can find one he hasn’t already come down on both sides of).

  2. P. J. O’Rourke was a bit ahead of the curve when years ago he said, “If you think Healthcare is expensive now, just wait till it’s free.”

  3. Great piece about the SCOTUS decision in the paper today, thought you’d like to see it.

    Canadians lament that they have few national myths. But as the health-care debate shows, an absence of myths makes policy-making easier. In the United States, where the Founding Fathers are treated as secular saints, where many “originalist” judges are trapped in a 1789-era reading of the Constitution, and where conservatives such as Ron Paul still imagine a country of frontier yeomen who can get their health care from neighbours and local well-wishers, Obamacare became a proxy for a larger and more vexing question: Can Americans still afford to entertain 18th-century political reveries when 50-million of their countrymen lack health insurance in the world of 2012?

    ‘A Canadian perspective on America’s ideological civil war over health care’, Jonathan Kay; National Post, June 26, 2012

    http://fullcomment.nationalpost.com/2012/06/28/jonathan-kay-a-canadian-perspective-on-americas-ideological-civil-war-over-health-care/

    • Of course that should be “June 28”.

    • Excellent article. It nails Ron Paul’s position, which I admit to being very closely in tune with since my dad was also an ob/gyn practicing in the ’60s, “the Golden Age of Medicine,” and that’s when I was getting my first health care as an adult. I can appreciate the difficulty Paul is having in getting past ideas from that era.

      However, I think the article totally overlooks the extremely polarized politics we have here now, where neither party is going to give an inch to the other, no matter what the issue. It’s turned into a fight to the death, and the American people be damned. True, the health care mess has been developing for a long time, but like immigration, no one wants to grab the tiger by the tail. No one wants to pay the political price for making the really tough decisions necessary to solve a huge problem. And while they keep tap dancing around the issue, the problem keeps growing …

      • Too many politicians ( with their excellent health care and retirement) No statesmen.
        Also do you know how many Canadian Doctors have moved to the US to practice medicine – and get away from their system? Many are filling spots in underserved/rural areas quite happily. I talked with one last week who is rushing to get some needed surgery done before having to return to Canada because it would be such a long wait there, it would cost twice as much out of pocket – and he’s not comfortable with the level of care he would get.
        Your last line above is so true.

        • I don’t doubt we have the best doctors in the world. We just don’t have enough of them. I hadn’t heard that Canadian doctors were coming here, but that says a lot about the systems in both countries. Nobody knows the systems better than the doctors who work in them.

          • The ‘Canadian doctors to the US’ thing is from a bureaucratic decision made in the 80’s. Someone decided Canada had too many doctors, so they changed a few rules. So, over the years, up to 8,000 Canadian doctors have moved to the US to practice.

            Because of this, of course, Canada is basically short 8,000 doctors. So we recruit them from other countries… including the US, Europe… everywhere else. And then spend years retraining them in Canadian universities so they can go work somewhere else. It makes no sense, but that’s how health care works in most countries.

            There are now programs in place to keep Canadian trained doctors in Canada, so the flow south has… lessened. Of course the US has been after our nurses as well.

            Canadians, I feel a need to point out, live longer than Americans, our maternal and infant mortality rates are way, way lower, and our ‘obesity rate’ is 14.3% vs the US at 30.6%. But there are a lot of reasons for that, and not necessarily only due to ‘publicly funded’ health care (we actually do have a lot of private health care up here as well).

            http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States

            • The doctor shortage of a few years ago is being resolved and Canada could be heading towards a glut of physicians, data in a new report on the supply of doctors suggest.

              The number of practising doctors in Canada is at an all-time high, with nearly 70,000 active physicians working in the country last year. Out-migration of doctors has declined, licensing of international medical graduates has increased and medical schools are pumping out record numbers of new doctors, said the report by the Canadian Institute for Health Information.

              That’s from ‘The Canadian Press’ as reposted / stolen and offered up on the Huffington Post (2011):

              http://www.huffingtonpost.ca/2011/12/15/doctors-all-time-high-canada_n_1151828.html

  4. I explained this on my FB. I’m using arbitrary numbers here, but say you are a contractor and make 50K a year. That’s probably too much for either Medicare or to get the subsidy. But if you’re someone like me, at my age, in the current system, insurance premiums are $540 a month, with a $2,800 deductible. That means I would pay $9,280 a year before ever seeing a *penny* of my benefits.

    Yeah, right. I’d pay for my meds and office visits out of pocket and take the 1% penalty on my taxes ($500). After accounting for meds, office visits, and the tax penalty, I’d still come out more than $7,000 ahead as long as I don’t get hit by a bus or something. Easy choice for someone whose greatest health risk right now is twisting a knee working out. However, as I understand it, premiums will be lower. That is the claim, anyway. It will be interesting to see if that happens. Also, I am curious to see what New York sets up as a health exchange, and whether various freelancer groups and unions will be able to offer more affordable rates. Alas, knowing the bureaucratic nightmare that is New York, I am not optimistic.

    • I had numbers like that for about a year after my COBRA ran out and before my Medicare kicked in. But at my age I didn’t dare not have insurance. I still don’t understand how the politicians think people like you can afford to buy insurance when ACA did not provide a public option as originally intended. I have no idea what the exchanges are likely to come up with, but it’s hard to imagine they will be able to offer policies for less than the cost of the penalty/tax. I share your pessimism.

  5. “Personally, I still don’t see what good it does to provide or require insurance for everyone when the health care delivery system itself is broken. It does no good to have health insurance if there are not enough doctors, nurses, and facilities to provide health care.”

    This is a point that has bothered me for some time. Particularly when I was in college and wanted to get into the medical profession. After looking at the hoops I was going to have to jump throgh, it was obvious to me that I wasn’t going to be able to do it, not and get married too. There was simply no choice, so I switched majors and went into technology. But, yes, I wanted to be in the medical profession, pathology in particular. And there was no help. I would have had to go out of state, and I already had too many student loans (which I am still paying off).

    One of the things I’ve bitched about before are the factors that increase health care costs and availability. To lower the cost of health care without lowering its quality should be a major goal. Instead, we spend time focusing on how to work within a broken system to provide more of the scant health care to more people. Where will the doctors come from? They’ll come from other countries. We aren’t producing enough of our own. That’s broken. What’s also broken is the prices of medication, the prices of medical equipment. It’s so much cheaper to get healthcare outside of the US that people are taking “healthcare vacations” to other countries, and those countries are catering to that. It’s ludicrous. Those that say Obamacare is a bandaid on the problem are correct. Of course, the Republican solution was to do nothing, so a bandaid is better than nothing.

    I don’t have a solution either. I don’t think anyone does outside of completely socializing medicine, which I still predict to occur at some point in the future. Obama didn’t have the balls to do it. The president who does will be vilified by millions for the massive tax increase it will bring. This pendulum will continue to swing, and right now, those who speak truth to power aren’t playing politics. If we can’t fix this two-party polarized bullshit, how can we fix anything else?

    • I don’t recall reading anywhere about how they think the existing health care system is going to deal with — what’s the number? 30 million? — more patients. ACA delivers 30 million new customers to the existing for-profit insurance companies. Not sure how that is supposed to help anyone but the insurance companies.

      My own primary care doctor, a young woman, has told me that when young people ask her about becoming doctors, she advises them to do something else.

      I worry about how much worse the situation will get before it finally gets better …

  6. Something interesting: At the end of working day yesterday, my sister-in-law (and a few others) was called in and her employer told her she was being laid off because they are a small business and must get under the minimum employee number requiring insurance by companies under the new Healthcare mandate.
    Thanks – the Healthcare bill is already making our family’s lives better

  7. “Give me Liberty, or Give me Death!” – Patrick Henry

    What a brilliant ruling by the United States Supreme Court on the affordable health care act (Obamacare). Stunningly brilliant in my humble opinion. I could not have ask for a better ruling on a potentially catastrophic healthcare act than We The People Of The United States received from our Supreme Court.

    If the court had upheld the constitutionality of the individual mandate under the commerce clause it would have meant the catastrophic loss of the most precious thing we own. Our individual liberty. Thank you! Thank you! Thank you! Supreme Court.

    There is no mandate to buy private for-profit health insurance. There is only a nominal tax on income eligible individuals who don’t have health insurance. This is a HUGE! difference. And I suspect that tax may be subject to constitutional challenge as it ripens.

    This is a critically important distinction. Because under the commerce clause individuals would have been compelled to support the most costly, dangerous, unethical, morally repugnant, and defective type of health insurance you can have. For-profit health insurance, and the for-profit proxies called private non-profits and co-ops.

    Equally impressive in the courts ruling was the majorities willingness to throw out the whole law if the court could not find a way to sever the individual mandate under the commerce clause from the rest of the act. Bravo! Supreme Court.

    Thanks to the Supreme Court we now have an opportunity to fix our healthcare crisis the right way. Without the obscene delusion that Washington can get away with forcing Americans to buy a costly, dangerous and highly defective private product (for-profit health insurance).

    During the passage of ACA/Obamacare some politicians said that the ACA was better than nothing. But the truth was that until the Supreme Court fixed it the ACA/Obamacare was worse than nothing at all. It would have meant the catastrophic loss of your precious liberty for the false promise and illusion of healthcare security under the deadly and costly for-profit healthcare system that dominates American healthcare.

    As everyone knows now. The fix for our healthcare crisis is a single payer system (Medicare for all) like the rest of the developed world has. Or a robust Public Option choice available to everyone on day one that can quickly lead to a single payer system.

    We still have a healthcare crisis in America. With hundreds of thousands dieing needlessly every year in America. And a for-profit medical industrial complex that threatens the security and health of the entire world. The ACA/Obamacare will not fix that.

    The for-profit medical industrial complex has already attacked the world with H1N1 killing thousands, and injuring millions. And more attacks are planned for profit, and to feed their greed.

    To all of you who have fought so hard to do the kind and right thing for your fellow human beings at a time of our greatest needs I applaud you. Be proud of your-self.

    God Bless You my fellow human beings. I’m proud to be one of you. You did good.

    See you on the battle field.

    Sincerely

    jacksmith – WorkingClass 🙂

    Posted by jacksmith | July 20, 2012, 10:27 am MDT

“We have met the enemy and he is us." ~ Pogo

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