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To point out the obvious on today’s Supreme Court Decision on the ACA

2012 June 28
by Ian Welsh

Roberts voted how he did because health insurance companies are absolutely desperate for the money they will get from the mandate.  All of the legitimacy arguments are bullshit, about 70% of Americans opposed the mandate.(pdf)  This is more similar to TARP than anything else: it is a massive corporate giveaway, opposed by the majority of the population, and passed over their dissent.

Watching so-called progressives shilling for forcing people to buy shitty insurance to subsidize health insurance companies has been another example of why I don’t call myself a progressive.  Yes, a few people’s lives will be saved.  The cost will be many lives destroyed.

Update: to make the other obvious point, that government can force people to buy largely unregulated corporate products is an important precedent for the oligarchy.

Update 2: to point out more obvious which apparently isn’t:

  • Roberts struck down Medicaid expansion, which means he closed the hole to creeping single payer
  • the ACA is a subsidy from the young and healthy to the old and unhealthy.
  • The subsidies to help buy insurance (which are insufficient to begin with) will nonetheless quickly become one of the biggest budget items, and will be taken away in the future.

Change: Changed from 70% oppose Obamacare to 70% oppose the mandate, link added.  The mandate is what progressives wanted upheld.  Note the deafening silence on the fact that medicaid has been screwed—the part that helps the poor most.

85 Responses
  1. Morocco Bama permalink
    June 28, 2012

    I agree, completely. I knew it would pass, didn’t you? And, for the very reasons you stated. Still, people fail to see the obvious. Heaven help us….which of course it won’t.

  2. Ian Welsh permalink*
    June 28, 2012

    I admit, I keep hoping that the right thing will be done for the wrong reasons occasionally. Still, no, I’m not surprised. Disappointed, but not surprised.

  3. someofparts permalink
    June 28, 2012

    and just to make sure every route to healthcare is closed to Americans, we have this

    http://www.treehugger.com/lawn-garden/gardener-sues-city-tulsa-cutting-down-her-edible-garden.html

    the supply of stupid is endless

  4. David R permalink
    June 28, 2012

    I think posterity will view the Roberts Court as the most corrupt SCOTUS ever seated. Still they’re nothing if not consistent: life, liberty and the pursuit of fiscal happiness for corporations – and everyone else can go piss up a rope.

  5. Bolo permalink
    June 28, 2012

    Where does your 70% number come from? Polls I see online show that its more like 40 – 52% opposed, with usually smaller numbers “for” and the “don’t know’s” making up the difference.

  6. David R permalink
    June 28, 2012

    Liberals are inane propaganda victims fully to the extent conservatives are and I’d given up on them along time ago but the depth of support among progressives was both surprising and appalling…….

  7. someofparts permalink
    June 28, 2012

    Just spotted this at Corrente. Seems to be another twist to the decision.

    http://www.correntewire.com/obamacare_the_market_state_and_nudge_theory#more

    key point (IMO) -

    “The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws. ”

    Attorneys are calling this a change to a new constitutional order – from the nation state to the market state

  8. June 28, 2012

    Roberts was the corporatist in this; the other four were full-on ideologues. Apparently for him, the interests of the 1% trumps the ideology.

  9. June 28, 2012

    The group hit hardest is going to be poor people in conservative states: don’t be poor in Texas or Florida. It is hard to believe this is not a deliberate policy decision upon the part of Roberts and his shadowy clients.

  10. Everythings Jake permalink
    June 28, 2012

    Far too many articles today about how Roberts just made the court his, his historic vote, the beginning of his legacy, the restoration of faith in America’s great system of jurisprudence.

    Meanwhile, it’s patently obvious that Roberts’ decision fits a well-established pattern of service to corporations at everyone else’s expense.

    Moreover, 46 million people in America are living in poverty – essentially on food stamps, and an additional untold number of millions are struggling as it is to get by, many foregoing health insurance to do so. Where is the money supposed to come from to comply with the mandate (or the penalty, aka “tax)? It’s not, of course, going to come from anywhere. The whole thing is a farce.

    The only sensible solution (in my very pale imitation of Jonathan Swift) is to start killing the rich. Take out, say, the Waltons first, eke whatever estate taxes the state is entitled to, and once the estate has passed to the survivors, start the process again (lather, rinse, repeat). I hope it will have the beneficial effect of wiping sociopathy from the gene pool, which is the only way the the species is going to survive at any rate.

  11. June 28, 2012

    Now we have to endure the absurd spectacle of progressives claiming … and celebrating … that Roberts overcame his ideological biases by voting for the corporate empowering ACA.

    I’m amazed that people find Roberts’ vote so surprising. His greatest ideological allegiance is to whatever favors corporate interests. Maybe the biggest surprise is that Alito didn’t also vote in favor of it.

    Z

  12. Bolo permalink
    June 28, 2012

    Best comment on my Facebook wall right now:

    “I think one of the most interesting things is how it protects the person rather than the Health Insurance Company. Must have made many health insurance companies mad that they can’t have a ‘cap’ but rather have to cover what they claim they are going to cover. Often politics seems to support the companies over the individuals and this health care legislation is an exception to that trend.”

    I think I’m going to have to stop reading my Facebook feed until after the November elections. Its just getting painful now.

  13. David Kowalski permalink
    June 28, 2012

    Two things are clear from this decision.

    1) Ideology may decide eight of the nine votes but Roberts is a corporate tool pure and simple. The Affordable Care Act let insurers set the ground rules and do whatever they wanted on health care. There are no limits to increases, no regulation of behavior and guaranteed profits at the expense of the 99%.

    2) Medicaid and other federal programs are no longer federal programs. Using the Roberts rationale, the Republican states can pick or choose what parts of the law they choose to “offer.” What side won the Civil War? Oh, the corporations and the south.

    Of course it was obvious that Obama cared for the corporations and not for expanding healthcare. The expansion came, in large part, through Medicaid, and that is seriously jeopardized.

    One side comment on “who won the war.” Under the TransPacificPartnership, Vietnam will be dictating US labor and internet access and who knows what else. What other ridiculous things will Obama and Roberts do for their corporate masters? There is no limit.

    To paraphrase the usually wrong Republicans, the justices (sic) only decide what is constitutional, not what is a good law and what is a bad one … except when the bad laws benefit corporate interests.

  14. Morocco Bama permalink
    June 28, 2012

    My oh My how this is being spun by Pravda….and Pravda in this sense, is the entirety of the U.S. mainstream press.

    This headline from Bloomberg….and I bet they had it written prior to the decision.

    Roberts Rejects Partisanship as Court Backs Obama Health Law

    It is so utterly transparent, and yet so effective.

  15. Benedict@Large permalink
    June 28, 2012

    Eventually the people will wake up to the fact that ObamaCare isn’t and was never meant to be “a good start” on healthcare reform. In fact, it was meant to PRECLUDE any further reform by releasing the political pressure necessary to force such changes. From now on, whenever anyone proposes further reform to healthcare, they will be greeted from the Right with howls of derision: “WE JUST GAVE YOU OBAMACARE. WHAT MORE DO YOU WANT.”

  16. jawbone permalink
    June 28, 2012

    I think Roberts is a long game planner and player. Whatever he did today will have points made which will further his objectives of returning the USA to a point somewhere between pre-Magna Carta and the Gilded Age of no taxation on the income of the rich. He had to be the one writing the decision, as his special points had to be made.

    And, yes, he knew Big Health Insurance Bidness desperately needs and wants that mandate. They were systematically raising the cost of their products well beyond the ability of the lower economic quintiles to pay for it. Now they’re forced to purchase, with assistance from the Federal government; either way, tax payers as consumers and taxed citizens will pay to preserve the profit structure of the Big Health Insurance Profit-makers (BHIP).

    And he didn’t want to hurt the fee-fees of those corporations, sensitive persons that they are.

  17. June 28, 2012

    Commented here.

  18. June 28, 2012

    Me too. Not surprised, but disappointed. Today I heard Michael Moore on “Democracy Now” go on and on how this is the doorway to total healthcare reform. “Now on to single payer!” “We are moving forward not backward on good health care”, said some woman on NPR. That’s what we are going to here from the Fat Cat News from now to election day and beyond. “It’s a start! Now we have to get Obama elected again.” Ugh.

    The bigger decision this week was the Montana case against Citizens United that was dismissed. The question still remains for some as to why Attorney General Bullock did not use the 11th Amendment argument i.e. the Supreme Court has no jurisdiction. Good interviews by TEAM (the eleventh amendment movement) on the Peter B. Collins show. http://www.11thamendment.org/

    Montana made the same old argument. But TEAM had a new argument. “Montana could have tried another play”. Now the Democrats will have a campaign issue. “That bad Supreme Court upheld Citizens United.” TEAM says the conservatives on the court are hypocritical as to states rights.

    This was a big deal that nobody covered.

  19. groo permalink
    June 28, 2012


    Watching so-called progressives shilling for forcing people to buy shitty insurance to subsidize health insurance companies has been another example of why I don’t call myself a progressive.

    Haha.

    forced me to have a look at the ‘devil’ once again:


    The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. There are no private hospitals or clinics as all health services are government-run.

    Like the rest of the Cuban economy, numerous reports have shown that Cuban medical care has long suffered from severe material shortages caused by the US embargo.

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

    To confuse cause and effect in the minds of the ordinary folks is the primary goal of propaganda, right?

    Here is Yves Smith citing Mark Ames:

    It’s like a classic case of East Bloc lumpen-spite: middle Americans would rather see the European system collapse than become beneficiaries themselves. If there is one favourite recurring propaganda fable Americans love to read about Europeans, it’s the one about how Europe is decaying and its social system is on the verge of imploding; we Americans pray for that day to come, with even more fervour than we pray for the End of Days, because the very existence of these pampered workers makes us look like the suckers and slaves we really are.

    http://www.nakedcapitalism.com/2012/06/why-dont-americans-take-more-vacations-blame-it-on-independence-day.html

    Difficult being a ‘Progressive ‘, when surrounded by such beliefs.

    On the other hand: brilliant move by the PTB, who tirelessly work on destruction and
    confusion, and seem to have their fun with that.
    As long as it lasts.

  20. Ian Welsh permalink*
    June 28, 2012

    Added a second update and points at the top.

    Agreed on Roberts being a long thinker.

  21. June 28, 2012

    Yay! The Heritage Foundation’s plan was upheld by a right-wing court! This is a great day for liberalism!

    What a farce.

  22. June 28, 2012

    Listen to that last TEAM interview on the link I provided. They said that the Montana case was by far more important than the Obama care decision. Either way the court decides the Obama care case, the health insurance corporations win. But by denying Montana’s states rights, the court decided that unlimited corporation money can be used in state elections too. The TEAM folks thinks this is the second worst judgment since the Civil War. The first was Citizens United.

    So here in Montana we are in a real bind again. Bullock is running for governor? He screwed up this case? He failed to use the 11th amendment. Why? He gave up our sovereignty, I think. I’m not a lawyer and never even played one on stage. Did he put his political ambitions before the people’s good?

    Our constitution is flawed. The Confederation was probably better. Adam Furlach of TEAM says that corporations have swallowed all three branches of Federal government. What we should have had left was state sovereignty.

  23. S Brennan permalink
    June 28, 2012

    From my Facebook this morning:

    What it means is the deconstruction of Social Security through the use of government mandated private annuities may proceed as planned.

    Meanwhile poorer/unemployed people will be fined for not buy buying high deductible insurance where even when the insurance pays [and it always tries not to] for a major illness the insured declares bankruptcy. Say you are making median wage of $26,364 [2010-HuffPo] and you have a minor heart attack with an average cost of 76,0000.00 USD [2010-CBS]. Assuming, your insurance pays [a big assumption on individual policies], your 6,000.00 USD deductible will be eaten up in one go [that's where the good news ends], with an 80/20 split on the remaining 70,000.00 USD you will pay 14,000 in addition to the 6,000.00 for a total of 20,000.00 USD! Let’s say you are 50 years old, you’ve been paying about 270.00 USD [CNN-2009] per month, or 3240.00 USD per year and lets say we split that in half, your out of pocket expense is 21,620.00 USD for the heart attack alone. That’s about 120% of your after payroll tax yearly income…off to bankruptcy court you go.

    If you own a house, you will lose it, because lost work time means you missed at least three payments, so our median wage “insured” heart attack victim losses everything under the Democratic “insurance” plan. Nice going guys!

    Not that everything is bad in the bill, it does improve around the edges, by enrolling more on Medicaid, instead of an estimated 60,000 needless deaths, we will have something closer to 35,000 needless deaths. That should thrust the US past 49th place [2010-Columbia University] in health care worldwide. But let’s be clear, by forcing additional costs onto states, who are already in financial straits, States are compelled to cut elsewhere. Gee, who do you think gets the short end of that stick? The 1 percent?

    Since the economic downturn in 2007 about 100,000 [American Progress] per week have lost their health insurance, if they have already lost everything, they can apply for Medicaid under this program, if not, they will be fined for not having insurance until they lose everything and can then apply for Medicaid. As the economy slowly improves [maybe not, we could be headed for another recession] these folks will have every incentive NOT to take work, because they would lose insurance and start paying the fine instead. Republicans will be sure to make hay out to this “free loading” and start hacking at Medicaid.

    This is what passes for wonkish “LIBERAL” health policy, no wonder the Supreme Court gave it a pass, it will gut liberal/progressive policy for the foreseeable future. When you see ignorant angry crowds of plebeians, egged on by Fox, wanting to string “Limousine Liberals” up by their necks, or voting “against their own interests” supporters of this monstrosity can be sure they played a vital role in the USA’s declining standard of living.

    Did I mention this does nothing to reduce the cost of Medical Care in the US, which is by a factor of 2, the most expensive in the world, which is the core problem? No? Sorry to go off topic, I know we don’t do solutions in the USA any more.

    http://www.scotusblog.com/2012/06/dont-call-it-a-mandate-its-a-tax/

  24. June 28, 2012

    Does anyone else think that Roberts deceived Scalia up to the very last moment? Is this this Supreme Court or the Sopranos?

  25. Mary Mac permalink
    June 28, 2012

    “Does anyone else think that Roberts deceived Scalia up to the very last moment? Is this this Supreme Court or the Sopranos?”

    The entire power structure is the mafia. See Taibbi.

  26. someofparts permalink
    June 28, 2012

    Montana Maven I’m really sorry to hear they dismissed that case. How do people in Montana seem to be taking it?

  27. jcapan permalink
    June 28, 2012

    “I think posterity will view the Roberts Court as the most corrupt SCOTUS ever seated.”

    Posterity seems to facing pretty long odds. For those “lucky” enough to survive the looming concussions, I imagine they’ll view things the way they’re told. The remaining dissidents, well, god help them.

  28. S Brennan permalink
    June 28, 2012

    jcapan,

    A dark, but humorous comment. Something close to what a fatalistic soldier might say.

  29. Jumpjet permalink
    June 28, 2012

    The only sensible solution (in my very pale imitation of Jonathan Swift) is to start killing the rich. Take out, say, the Waltons first, eke whatever estate taxes the state is entitled to, and once the estate has passed to the survivors, start the process again (lather, rinse, repeat). I hope it will have the beneficial effect of wiping sociopathy from the gene pool, which is the only way the the species is going to survive at any rate.

    You could always start by taking out Roberts. Between this decision and Citizens United he’s established himself as an unabashed Enemy of the State. Plus, I’m sure his home is far more modest, and far less secure, than the Waltons’.

  30. June 28, 2012

    I with Ian and most of the rest of you guys on this. I felt lonely and isolated myself when I saw the hootin’ and hollerin’ coming from my “progressive” liberal friends on FB (and, of course, I had to scoot by TBogg’s place because I must like pain or something). Rather than take up space here (because you all know how shy I am about doing that), I respectively direct you to this post:

    Once Again, Supreme Court Blesses The Ever-Ongoing Corporate Takeover Of America

  31. June 29, 2012

    I’m glad liberals are all so thrilled that health insurance companies are going to be selling so many more policies. Yes, I know this is better than nothing, and all that, but unlike everybody else in the liberal camp, I actually think that legislation which makes health insurance companies bigger and more powerful, more in control of the health care delivery system, is a very long way from the best thing that can be done for this nation.

    I know, there is all the wonderful things about how they cannot turn down people and must keep kids until age 26… Awesome. They are required to have all of these additional paying clients whether they want them or not. Makes your heart bleed for those insurance companies, doesn’t it; saddling them with all of that additional revenue?

    Where are the regulations limiting insurance premiums? The 80% “medical loss ratio” thing? No, actually that’s a regulation insuring that they do make a profit, because whatever their costs are they are allowed to add 25% to that to determine their selling price. It’s the “cost plus” thing that Pentagon procurement is so fond of. In any case, that is not a “health care cost” issue, that is a “health insurance price” issue.

    Health care costs are generated by hospitals, physicians, drug companies and the like. Where are the regulations saying that a hospital can’t charge you $300 for a blanket that they let you use for five minutes before surgery? Where are the regulations that say a hospital can’t charge $1000 to one insurance company for a procedure and $3000 to a different insurance company for the same procedure? Where is the regulation saying that a drug company can’t charge $100+ for a pill that costs them 50¢ to make?

    An insurance company must spend 80% of its pricing on cost, but a hospital is not limited in anything like the same way. Its costs might very well be only 40% of the amount that it bills. Drug companies might have costs that are only 35% of what people pay for drugs.

    So the insurance companies pay the outrageous hospital costs, pay the outrageous drug costs, pay the $2,000,000 doctor salaries, and then they add 25% to that and pass it on to be paid by the people who are being treated. And we are cheering lustily because instead of fixing that broken system, we simply require more people to participate in it.

  32. Celsius 233 permalink
    June 29, 2012

    OMG! So many willing to die! Hanging on to every word of the Supremes. The most corrupt court in many decades. These guys are the real enemies. Shit; they usurp the constitution in it’s own name! Fuck them! Disgusting; just fucking disgusting…

  33. Bill S permalink
    June 29, 2012

    Agree with Bolo on the 70% number ….
    and I wonder about the “few” getting saved? is that 3 people or is it a few hundred or a few thousand? or ?? and that this law alone will destroy many more lives? How is that called out in this law? by the mandate (tax)? or is it the medicaid part you address there?
    and MontanaMaven …. I have never thought of Michael Moore or Amy Goodman as being part of the Fat Cat News. and one more thing ….. just think how many other states have been living in a screwed “state” for so long? FL, AZ, MI, OH, PA, WI, ME, the whole confederacy and the Morman west.
    You have company.

  34. StewartM permalink
    June 29, 2012

    Roberts was the corporatist in this; the other four were full-on ideologues.

    I wouldn’t be so sure about that. I think that someone of them had to be the Right’s “rotating villain” and this was Robert’s turn. After all, Roberts and Scalia and Thomas have all attended Koch-funded secret strategy events.

    And there’s evidence that this was an 11th-hour change as well:

    http://www.forbes.com/sites/rickungar/2012/06/28/did-justice-roberts-change-his-obamacare-vote-at-the-eleventh-hour/

    Of course, Roberts being concerned about the court’s integrity is hokum. What is more likely is that it was decided that he should be the conservative villain who pushes it over, while striking down the only useful part of the ACA.

    -StewartM

  35. StewartM permalink
    June 29, 2012

    Man, an edit function would be so handy:

    Roberts was the corporatist in this; the other four were full-on ideologues.

    I wouldn’t be so sure about that. I think that someone of them had to be the Right’s “rotating villain” and this was Robert’s turn. After all, Roberts and Scalia and Thomas have all attended Koch-funded secret strategy events.

    And there’s evidence that this was an 11th-hour change as well:

    http://www.forbes.com/sites/rickungar/2012/06/28/did-justice-roberts-change-his-obamacare-vote-at-the-eleventh-hour/

    Of course, Roberts being concerned about the court’s integrity is hokum. What is more likely is that it was decided that he should be the conservative villain who pushes it over, while striking down the only useful part of the ACA.

    -StewartM

  36. StewartM permalink
    June 29, 2012

    the ACA is a subsidy from the young and healthy to the old and unhealthy.

    That’s why the middle class resents welfare programs, and the lower white working class resents welfare and affirmative action programs, and why non-union workers resent union workers. The current Turd-Way “liberal’ solution to help the have-nots is to take from the have-a-little-mores to give to the have-nots. Never to take from the elites at the top to give to both.

    The ACA is also geared to degrade the insurance plans of those in the middle- or working-class who have “good” insurance (aka on par with what *everyone* gets elsewhere in the developed world) into shitty insurance so that they’ll have shitty insurance just like the poor do. The “Affordable” bit in the ACA means “affordable for the elites”, not “affordable health care to everyone”.

    I expect a life expectancy drop from the ACA.

    -StewartM

  37. StewartM permalink
    June 29, 2012

    Oh, and if Mittens wins this November, there’s just about the same chance of the Republicans “repealing Obamacare” as there is in Obama prosecuting war crimes. I predict a kabuki theater where this time it’s the Republicans suddenly become helpless against not having 60 votes in the Senate. Who will be their Joe Liebermann?

    -StewartM

  38. June 29, 2012

    I doubt that the court has a rotating villain on their right wing … on any wing. On what prior decisions has this right wing villain shown up?

    I tend to think that Scalia is legitimately pissed off about the whole thing and may have had something to do with his incorrect references in his opinion to the minority making its way through editing. Who knows, maybe he’ll even quit over Roberts’ change. Doubtful, but if I could get 100-1 odds on him stepping down over the next year I’d put some money down on it. He could have wanted the people to know what happened: that Roberts changed his vote, and had it left in there to do that and also to send a ‘pre-fuck you’ to Roberts … along with his railing against the Obama Administration in a recent ruling … before he walks away.

    Scalia has quite an ego mind you. This may have been his majority decision to write. This may have been his stage on a major case and Roberts may have stolen it from Scalia at the last minute by changing his vote.

    And Roberts did use a results-oriented “threading the needle” type of argument to justify his decision. Scalia is very good at deconstructing arguments. IF Scalia knew that Roberts changed his vote once Roberts knew that ACA was going to be overturned 5-4 and Scalia doesn’t respect Roberts reasoning for his change of face it would gall Scalia. Scalia is less of a corporate tool than Roberts and Alito.

    Hell, it would make great theatre: Scalia going out with some ego-enrichening, self-righteous indignation … going out loud and proud as a conservative hero riding off into the sunset with his head held high. And if and when he wanted to make some seven figure money from home … and write about his favorite subject … he could pen an autobiography and market the entire book around a couple of cryptic paragraphs he includes in it on why he left the Supreme Court shortly after the ACA decision.

    The funny thing is, is if that happened and Scalia believed that Roberts changed his vote simply to change the outcome, he’d probably think it was due to some perceived pressure from the Obama Administration and probably never seriously consider the possibility that it may have been to please corporate interests more than the White House’s.

    Z

  39. June 29, 2012

    Yeah, if Romney won the republicans would probably be subjected to the same mind-numbing kabuki threatre that the democrats have suffered through so often during Obama’s reign in regards to Romney “trying” to overturn the corporate empowering ACA. It would be interesting to see how that all played out. For some reason I don’t think that the right would be as subservient to Romney as the “left” is to Obama.

    Z

  40. StewartM permalink
    June 29, 2012

    On what prior decisions has this right wing villain shown up?

    There’s simply been no need up until now.

    The “rotating villain” tactic is employed when you are determined to serve your real (corporate, rich, elite) master yet you have riled up your voter base by alleging that you are earnestly trying to do something quite the opposite. With the Right, on economic issues, the public positions of the Republican party and the interests of the elite are fairly well meshed together, so there is usually little real need for a rotating villain. This would make a rare exception.

    On social issues (which are ‘red meat’ issues for much of their base but for which the elites care little) there can be rotating villains–or at least feigned helplessness, as the Republicans can never get around to outlawing homosexuality like they can lower top tax rates.

    For some reason I don’t think that the right would be as subservient to Romney as the “left” is to Obama.

    Their voting base wouldn’t be. But eventually all the Fox News commentary would make a dent.

    -StewartM

  41. June 29, 2012

    “Yes, a few people’s lives will be saved. The cost will be many lives destroyed.”

    I absolutely, positively, utterly hate the fact that I’m one of the former. I don’t hate that my life will be saved, of course, but the fact that I have to set my personal interests against those of the society generally is about more than I can stand.

  42. Morocco Bama permalink
    June 29, 2012

    They say a picture is worth a thousand words….this one surely is. It says more than a thousand. It would be a great class lesson to plan an essay around it, accpet considering the state of education these days, most wouldn’t get beyond “ummmm.”

    https://sphotos.xx.fbcdn.net/hphotos-ash3/548833_10150882167781491_956128840_n.jpg

  43. S Brennan permalink
    June 29, 2012

    A top surrogate for President Obama insisted Friday that the individual mandate in the Affordable Care Act was not a tax — despite the fact that the Supreme Court narrowly preserved the law on those grounds. Massachusetts Gov. Deval Patrick [D] told reporters “This is a penalty,” Patrick said. “It’s about dealing with the freeloaders.” In fact, in court arguments the administration said it was a tax*.

    I agree with Gov. Deval Patrick [D] contention that the administration was being deceitful in arguments before the Supreme Court, where I would beg to differ is in the characterization by this DEMOCRAT [speaking for Obama] of the working poor as “free loaders”. This statement should clarify for posterity how far removed the Democrats of 2012 are from the party of FDR.

    The former Democratic Party of FDR overcame the world wide depression, the combined military power of the Nazi’s & Imperial Empire of Japan, the scourge of segregation, all the while electrifying the nation, fighting a Nuclear Armed nation to a standstill, dramatically reducing poverty, landing a man on the moon and providing for the general welfare to such a degree that we were the envy of the world in 1969.

    The current Democratic Party, is systematically returning the nation to a pre-FDR construct, more akin to 19th century economics, minus the benefits of Mercantilism along the lines of the discredited economist Milton Friedman. What a legacy to reject, what a waste, what a disgrace to return to the corruption that was endemic to the gilded age. I pity todays children who will live in a fallen empire when it crumbles from within.

    *Solicitor General’s Third Backup Argument Is a Winner in Health Law Case, – “Solicitor General Donald Verrilli cited the taxing power in the administration’s third backup argument before the court” – American Bar Assc. Journal

    http://www.politico.com/politico44/2012/06/obama-campaign-its-a-penalty-not-a-tax-127721.html

  44. Morocco Bama permalink
    June 29, 2012

    to such a degree that we were the envy of the world in 1969.

    And no one loved us more than the North Vietnamese. Of course, they’ve come around….they always do.

    http://travel.nytimes.com/2007/02/18/travel/18hanoi.html?pagewanted=all

  45. Bill S permalink
    June 29, 2012

    Disagree about progressives or liberals wanting the mandate. They do not like it and that is why the penalty clauses have been softened to the point they have. A few hundred, maybe a grand? but you are correct many will buy and provide the margins for the insurance cartel.

    Really? all this talk about the left are subservient and gullible? this is true to some extent, but probably more so for conservatives driven by fear and hate. Good thing everyone here won’t fall for anything!

  46. tom allen permalink
    June 29, 2012

    Michael Moore: “On to single payer!”

    Oops. The Progressive Caucus says sorry, no way, too much of a bother, but hey, don’t let that stop you from sending campaign contributions!

    “Rep. Raul Grijalva (D-Ariz.) said Thursday that the Supreme Court’s decision to uphold the constitutionality of President Barack Obama’s health care law means progressive lawmakers won’t be pushing for a single-payer option anymore, though the concept will live on in their minds.”

    http://www.huffingtonpost.com/2012/06/28/single-payer-option-health-care_n_1634853.html

  47. groo permalink
    June 30, 2012

    @tom allen,

    this is Michael Moore


    MSNBC PRODUCER: I read on your blog today that the fight wasn’t between red state and blue state any more, but rather between —

    MOORE: Yeah, I think when they say it’s a divided nation, it’s about liberals and conservatives, or Republicans vs. Democrats. The real divide in the country is between those who believe that Adam and Eve rode on dinosaurs six thousand years ago – and all the rest of us. That’s the divide. Between the people who’ve been fed a lot of misinformation, and fear, um – and those who operate with facts, who believe in science. Um, I think that that’s – for that divide to come more together, we have to have better education and better media so that so many million Americans don’t believe what they actually believe.

    The richest people in the country, the ones who aren’t done with us yet because they still don’t have enough wealth, have done their best to dumb down the population through destroying our educational system and using media to provide them with a vastly distorted sense of reality. The rich’s only obstacle is that they only hold 1% of the votes in the country. So they have to try to get a slim majority of Americans to vote their way. And fear, plus keeping them stupid, usually works.

    http://newsbusters.org/blogs/tim-graham/2012/06/29/msnbc-urges-michael-moore-praise-roberts-attack-those-who-believe-adam-a

    I think Moore is right on this one, but -all in all- it does not change a Iota.

    Adding one wheel on a car with none to begin with energizes the dumbos to such an extent that

    If the Affordable Care Act cannot be got rid of by peaceful means, armed insurrection may be necessary.

    http://agonist.org/kathykattenburg/20120629/crazy_crazier_craziest

    The 300 pound couch-potatoes mired in a phantasy of the wild-wild west, planning an insurrection?

    Is this a scene from North-Korea or Monty Python or what?

    My goodness.

  48. groo permalink
    June 30, 2012

    to Your enjoyment:

    this is a list I excerpted from a strange person’s compilation of a
    post-Machiavellian ‘ DO-NOT-DO LIST’
    (Smarandache — http://fs.gallup.unm.edu/GlobalTotalitarianism.pdf )
    slightly edited, because of his sometimes bad english.
    (Mine is not perfect either. Maybe I should not have done that, because his method would be more visible then. Anyway)

    –People are guided, exclusively, only by their small passions, by their habits, traditions and their sentimental theories;
    –Corruption, deception — betray to reach your goal;
    –Being sincere and honest you loose for sure;
    –Say something, and do something else;
    –Pose as a tame lamb, as victim;
    –To obtain influence, remain in the shadow;
    –Sometimes you may have to cooperate with your enemies;
    –Corrupt some, recruit others (I. M. Pacepa, “Red Horizons”, 1987);
    –Compromise someone to make him work for you;
    –Use conflicts to harden yourself;
    –To deserve a myth, produce yourself one;
    +–Sometime you have to sacrifice some of yours (blame the adversary);
    – In war there are simulated shot guns (giving the impression of real shots);
    – Ideology is a narcotic for the obedience of masses in any country;
    – Betrayal of allies or friends is common;
    – Do someone wrong and tell him that you did him good (!);
    – be without moral scruples;
    – Be without shame;
    – victories and defeats are always temporary;
    – If you live amongst wolves, learn to howl;
    – agreements are made to be broken;
    – No power without money;
    …etc, etc.

    After You have read that (or not) see here for a warning:
    http://planetmath.org/encyclopedia/florentinsmarandache.html
    He is sort of a Dada-’scientist’, but there is some method in his madness.

    Actually the perfect embodyment of a (mad) scientist of the teabagger flavor.

    How many are out there, who actually LIVE this?
    Quite a lot, it seems.

  49. June 30, 2012

    That’s some high comedy, @groo. Look’s like Smarandache hasn’t internalized his “post-Machiavellian” (“post-”? Looking at the commentary at the planetmath.org link, it’s probably closer to more “plagio-Machiavellian”) tenet you’ve offered in your paraphrased list:–To obtain influence, remain in the shadow;I’m inclined to go with the opinion expressed on his Wikipedia controversy:Keep it. Notable doofusAlthough, as M. Moore pointed out (another who ignores the influence/shadows advice, albeit less ironically), there may be a critical mass of folks “with a vastly distorted sense of reality” who could be relied upon to read him with less of a comedic eye.

    What a curious and sadly entertaining world we live in.

  50. groo permalink
    June 30, 2012

    @petro,

    to be clear, Smarandache is on ‘our’ side, and he is extremely intelligent.
    So much so, that up to now I could not figure out when he is joking and when he is dead-serious.

    He definitely is worth a second look.
    see him here:
    http://fs.gallup.unm.edu/FlorentinSmarandache.htm


    Poet, playwright, novelist, prose writer, tales for children, translator from many languages, experimental painter, philosopher, physicist, mathematician.
    American citizen.

    see the ‘joke’ he swindled in with the last item? The only one he separated by a fullstop on an extra line.
    He is a specialist in the paradoxical.

    Therefore eg his ‘Neutrosophic Interpretation of the Tao Te Ching’, which is an exercise in multivalued logic.

  51. Stew permalink
    June 30, 2012

    I disagree on two points: 1. every single payer health care system in the world is “a subsidy from the young and healthy to the old and unhealthy” that is the whole point of a pool and of covering everyone and spreading the cost. It doesn’t matter how good the health care in your country was early in life, old age is riddled with health issues, but also obesity exists elsewhere, tanning exists elsewhere, smoking as well. The health issues of the elderly, the lung cancer, skin cancer, diabetes is all covered and the cost is spread amongs everyone. Now I get that this has been exponentially increased in America, but it is still the case with the cost of EVERY universal health care system (not that ACA is universal health care, but we all know that). More importantly point 2 is that this is most definitively not that because there is no real guarantee of health care in this system. Despite the supposed controls in the law, we well know that regulations in America were made to be ignored, and weakened and gutted. This is actually a giveaway from the working people of America to the major stockholders of the Insurance companies and the Pharmaceutical companies which is really about wealth not age or overall health.

    Otherwise pretty much right on.

  52. groo permalink
    June 30, 2012

    sorry folks, actually, I do not understand this whole debate — or do I?

    See:

    Why does health care in Cuba cost 96% less than in the US?

    January 5, 2011-When Americans spend $100 on health care, is it possible that only $4 goes to keeping them well and $96 goes somewhere else? Single payer health care [government-funded universal health insurance] advocates compare US health care to that in Western Europe or Canada and come up with figures of 20–30% waste in the US.

    But there is one country with very low level of economic activity yet with a level of health care equal to the West: Cuba.

    Life expectancy of about 78 years of age in Cuba is equivalent to the US. Yet, in 2005, Cuba was spending US$193 per person on health care, only 4% of the $4540 being spent in the US. Where could the other 96% of US health care dollars be going?

    http://links.org.au/node/2082

    What is going on here?
    Capitalism is supposed to be the most efficient system to provide for needs and wants.

    Now a whopping factor of 25 is something to consider, right?

    My take on that is, that healthcare is mostly a service, with the addition of some
    a) apparatus like CT/MRI , CT/PET tomography
    b) pharmaceuticals, protected by IP

    Now, as we know, thoses are nice-to-haves, but wrt overall efficiency, and capitalism is supposed to be efficient, right? This, obviously, measurably, adds little.

    In econometric terms this is a terribly inefficient system.

    I suppose it has something to do with a fundamental rift between productuion of material goods, (drugs, instruments), where capitalism is efficient, but leads to a hyperexponential explosion of maintenance and all sorts of legal issues, and the basic care for the sick, which is diagnosis and simple treatment with cheap, nonpatented drugs.

    The factor 25 between Cuban and US- healthcare explains itself by intermediate layers of rent-seekers, advertisers, lawyers, drug-producers with drugs of minimal efficiency etc, which all in all leads to this whopping factor.

    The western health-care-industry (with the US leading by far) is probably the most inefficient of all capitalist endeavors, and should be exposed as such.

    May some economist stand up and analyze this!

    THIS is the problem and not ‘Obamacare’ or whatever you call it.

  53. Morocco Bama permalink
    June 30, 2012

    groo, yes, that is the problem and obamacare does address it….obamacare ensures that the inefficient, wealth-concentrating scheme that is our healthcare/health insurance system continues into the foreseeable future, unabated..until we’re all paupers.

  54. Ian Welsh permalink*
    June 30, 2012

    I can assure you that until I was about 30 I was not subsidizing the old and sick, because in a progressive tax system like Canada’s I wasn’t paying squat in the way of taxes, because I hardly made any money. In a progressive system, people who make more money, subsidize. Now, since then, certainly. But there is a real difference, and not just that if you DO get sick at 20, you don’t have low deductible crap insurance.

  55. June 30, 2012

    Oh – he was being ironic after all. Duh.

  56. Morocco Bama permalink
    June 30, 2012

    To me, one of the more draconian features of this piece of shit legislation is using the IRS as the enforcement arm to bully those who standards of living are slipping precariously away into submission. The IRS can literally ruin your life….for good, and that is exactly what is going to happen with this legislation…it’s going to force people into criminality as their only means to survive, and then lock them up in labor camps when they do ala Cool Hand Luke. There are so many ways to the poorhouse in the foreseeable future and this legislation is just grease on the slide into destitution….where this no Catcher In The Rye.

  57. groo permalink
    June 30, 2012

    if I let my inner cynic have a word (whom I always have to suppress)

    Fear is the most profitable emotion, so
    a) keep fear up in such a way that it APPEARS as reducing fear
    b) profit in such a way that it APPEARS as being a humanist project

    Pray.

  58. groo permalink
    June 30, 2012

    which, ofcourse also applies to eg the issue of climate change.

    The third ingredient: basic logic and an understanding of physics is necessary to distinguish between justified fear and the artificially implanted one.

    Difficult.
    Not the business of the average Jones.
    This difficulty: distinguishing between these two is exactly the weak spot, which is exploited eg by the Koch brothers and their likes.

    Emotion trumps the rational faculty of most folks most of the time.
    This is well known by the manipulators.
    Plus: It is easy!
    Switch off the rational faculty, which is fragile and depends on sensible education.

    Keep the emotions boiling!
    Cold logic is an enemy.

    Here we are.

  59. StewartM permalink
    June 30, 2012

    every single payer health care system in the world is “a subsidy from the young and healthy to the old and unhealthy”

    As per your argument goes below, if health care needs increase with age, then it just becomes part of the social contract. When you’re very young, someone looks after you, and society spends money on you (in schooling). When you’re middle-aged, you support both the very young and the old; the latter being the ones who paid the bills for *you* when you were young. When you’re old, you’re on the receiving end again.

    All that Social Security and health care programs are then is the modern representation of what people have always done, as state programs.

    It doesn’t matter how good the health care in your country was early in life, old age is riddled with health issues, but also obesity exists elsewhere, tanning exists elsewhere, smoking as well. The health issues of the elderly, the lung cancer, skin cancer, diabetes is all covered and the cost is spread amongs everyone. Now I get that this has been exponentially increased in America,

    Actually, factually, America stacks up pretty well compared to many other countries in regards to healthy living habits (most European countries outsmoke us and drink more heavily than us). The fact that they outlive us is because *they* get health care and many of us do not. That says something about how important this matter is, and the importance of getting it done right.

    -StewartM

  60. General Washington permalink
    June 30, 2012

    Obviously, in all the (wrong-headed) celebration and subsequent (almost enjoyable) derogation, the potential consequences of the mandate being upheld under Congress’ taxation powers – rather than the Commerce Clause – has been overlooked almost as much as the related gutting of the Medicare expansion…

    http://www.scotusblog.com/2012/06/a-marbury-for-our-time/#more-148208 (just go right to the eighth paragraph from the top)

    Looks like Barry really fucked America this time!

  61. Ian Welsh permalink*
    July 1, 2012

    Americans EAT much worse than most European nations, and have much worse social ties. Those two things far outweigh drinking and smoking, and short of alcoholism, drinking is not harmful, and is probably even good for you (I say this as someone who virtually doesn’t drink at all.) No European nation is even close to as obese as Americans are.

  62. Ian Welsh permalink*
    July 1, 2012

    Yes, gutting Commerce is a bonus. It’s not so much that it was upheld under Taxation, not commerce, as the details of the decision. As a progressive/liberal I would not have signed off on this decision under any circumstances even if I wanted the mandate. The price is too high.

    Roberts is a smart cookie. An evil cookie, but a smart one.

  63. groo permalink
    July 1, 2012

    @StewartM,


    The fact that they outlive us is because *they* get health care and many of us do not. That says something about how important this matter is, and the importance of getting it done right.

    I think not.
    I construct my argument from memory, but could back it up with hard references if You wish.

    As a reference I choose life expectancy, which ofcourse is a complicated mixture of infant mortality up to care for the elderly.
    Main reference is http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
    ‘Quality of life’ would be another measure, but this is a difficult one.

    A decently good first approach of the effectiveness of a health-care-system would be
    (life-expectancy)/(healthcare-cost), where one first notices, that L-E varies VERY LITTLE, H-C-expenditure VERY MUCH.

    –2nd part below.

  64. groo permalink
    July 1, 2012

    –2nd part

    Anyway.
    Now, eg the Greek (#19) are heavy smokers, but have good air, healty food, lot of sun (vitamin D), as the saying goes.
    The northern countries (eg Finland (#25)) have excessive salt intake (heart attacks), are potentially heavy drinkers (liver diseases) and suffer from depressions because of a lack of sun, as this saying goes.

    The Danish (#36) are known to care little about health, go about 3 times less to the doctor than eg the Germans (#21)
    Now compare (L-E):
    Greece (79.5)
    Germany (79.4)
    Finland (79.3)
    Denmark (78.3)
    US (78.2)
    Cuba (77.0)
    …Total healthcare costs in Greece are estimated as €23.6 billion; smoking-related conditions account for about 14.4% of the total, approximately €3.4 billion.
    (This number comes from a lobby-group. So it -ahem- should be taken with a grain of salt )

    So healthcare-cost is about 8% of Greek GDP, 15% of US GDP.

    Which again is misleading, because per capita GDP is 26k$ in Greece, 48k$ in the US.
    So, EFFECTIVE spending in Greece is approx 1/4 of US spending.

    So why is that?
    Blame it on the poor and blacks, who distort the US-statistics?
    Praise the healthy food of the Greek, which again compensates for their heavy smoking?

    If the controvery goes on, I maybe make another round of deconstructing some myths.

  65. groo permalink
    July 1, 2012

    what are the core-events, which determine the statistics wrt life-expectancy/cost?

    a) infant mortality (wrt life-expectancy)
    b) life-extending measures (apparatus-medicine, 1-6 months)

    (a) is comparatively cheap, and explains much of the statistical advantage of northern-european countries, which excel in keeping infant mortality low.
    (b) is comparatively expensive. If you ‘invest’ in life-extending measures on the far end, this cost distorts the statistics.
    So what one would wish, is to separate the issue:
    (i) infant mortality
    (ii) end-of-live-expenditures
    (iii) ‘normal’ health issues >1-y-birth … <1-y-end-of-life

    Those two borderline issues could be separated and are COMPLETELY independent from (iii).
    Would this be inhumane?
    In the case of (i) definitely not.

    In the case of (ii) this is completely different, and I leave this onto Your judgement.

    (iii) is the difficult case, constrained between 'hope' and 'fear', which is massaged by the health-care-industry.

    Because we do not have a believe-system anymore, however ridiculous, industry helps us and provides us with one, as a bypackage to the deal.

  66. David Kowalski permalink
    July 1, 2012

    Insurance companies inflate the costs of medical care by more than the 25% mark up. We always exclude the costs that health care providers spend on insurance companies. These costs are substantial, pervasive, and surprisingly extensive.

    My “significant other” runs a five surgeon practice and I have a good view of these additional costs. Not only does the surgical group employ billers but they employ a large number of other people directly related to the insurance companies. Surgical bookers need to check with the insurance companies to see if the surgery is pre-approved. Diagnostic workers have to schedule tests (and insurance) with other doctors before the surgery. Billing programs, clinical and data base programs and others have to be bought and maintained.

    The doctors and PAs must on occassion work through the insurance companies who are intent on denying coverage if possible. Intake workers spend time taking down insurance information. Supervisors and managers constantly review the data to see if it is complete and to avoid consternation from the doctors from denials and rigamarole.

    The hospital has an even larger set of people doing the same things.

    I suspect that the mark up is closer to 35% than it is to 25%.

    All that and we get to the most significant surcharge of all: “free enterprise” and “the market.” Doctors, at least these doctors, and hospitals do not make fixed wages or salaries. They are paid by the case and the patient and the payment varies widely depending on the insurance or payment. Strangely, among the very best payers are very rich foreign residents from the middle east or (in a much smaller subset) Latin America. It is an American market in luxury goods.

    Groo, other costs can substantially add to medical care. Last year within a six month period I was hospitalized for four different periods ( a total of six stays because two were at the nearest emergency room (total of 46 hospital days) and also spent 64 days in rehab. That period ended 7 and 1/2 months ago so it obviously was not at the end.

    My cardiologist set it off by prescribing the wrong medication which lowered my blood pressure to 41/28 in about an hour. Yes, this is the same problem (congestive heart failure) that Baucus insists should be treated by internists. Fool (and also tool).

    Part of the obesity problem has to do with diet and lack of exercise. In my case I lost 100 pounds when the excess water due mostly to diabetes was shed. My shirt size went from 2X to medium. My brother who looks thin to way thin has a terrible diet full of sugar and not much else except some burgers. Vegetables? Nah. He’s got off the chart cholesterol and other issues.

    I would argue that a lot of the other cost problems are due to private enterprise and greed. It is the $2 million plus “earned” by a 30 year old doctor or the larger amounts earned by more experienced doctors.

    The University of California did a series of studies recently that showed that wealthier people were less likely to obey the rules, were terrible drivers, had lower more and ethical standards on the job and generally felt entitled. Google “California greed” and get the press release from the UC-Berkley.

  67. July 1, 2012

    Great input, @David Kowalski. Yes, the very *existence* of insurance midwifing always drives up costs. It has no place in providing basic human needs.

  68. July 1, 2012

    *prices, not costs…

  69. S Brennan permalink
    July 1, 2012

    Good comment DK, I’m pretty sure if costs were accurately summed in totality, insurance is 30-35% of US’s Medical costs. E’ffing ridiculous.

    To Ian’s point “No European nation is even close to as obese as Americans are.” I would add, no European nation is even close to amount of hours worked per year, the lack of vacations and days off that US workers are. Add to that much longer commutes, which is WORK whether paid for or not.

    Sitting in front of a terminal all day is BAD for you, European statistics are going in the wrong direction on obesity too…just not as fast. Having an extra ~1.5-2.0 hours a day is going to build up in term of exercise and food prep. Taking a vacation every six month is going to lower your stress level which has been repeatedly associated with over eating. Having some form of financial security is also a factor in this area.

    Our Overlords are EXTREMELY stingy and the results of their abuse are plain to see…it may have satisfied those not so abused to diminish the serfs as nothing more than farm animals, [as was the case when the middle class joined the 1% in disparaging factory workers in the 1970's], but now that the shoe is on the other foot…things don’t look so good.

  70. groo permalink
    July 1, 2012

    @David K

    appreciate Your report!


    Strangely, among the very best payers are very rich foreign residents from the middle east or (in a much smaller subset) Latin America. It is an American market in luxury goods.

    Not only there. I worked on an osteporosis-project in the late 1990s, where the most solvent patients came from Saudi Arabia, who basically were willing to pay any price for their health, which is a strange way to recycle oil-dollars, right?

    My main take is , that there is a strange complement between ‘export’ of poor cuban doctors on the one side, and ‘import’ of rich oily patients on the other side.
    What ‘economic theory’ applies to that?

    See:
    In a quite absurd manner, economics assumes equal actors, competing for ressources.
    This is a myth, and more: a lie!

    Hope You have the personal distance to notice this strange disconnect.

    All the best!

  71. Ian Welsh permalink*
    July 1, 2012

    Long term stress is about the worst thing a body can experience. It correlates with about every bad chronic condition in existence, and there’s good reason to the think the link is causal in many cases. The American economy is extremely stressful: the way companies and bosses treat workers is calculatedly inhumane on a daily, heck, hour by hour basis. American bosses are, as a group, assholes.

    David: an article I once read had an American physician visiting Canada ask to see “the billing wing”. They took him to the billing “room”. A good friend of mine who’s a shrink left California to come to Canada, in large part so he could actually treat patients w/o having to deal with insurance companies, both in terms of denial and in terms of just not dealing with them for patients who do have insurance. Moving has been hard on him, but he tells me his work life is much better. He didn’t become a shrink to to get rich or do paperwork, he became a shrink to help people.

  72. StewartM permalink
    July 1, 2012

    Ian Welsh

    Americans EAT much worse than most European nations, and have much worse social ties. Those two things far outweigh drinking and smoking, and short of alcoholism, drinking is not harmful, and is probably even good for you

    There is no such thing as a “European diet” and no, on average they don’t eat a lot more healthy than us. In fact, Europe’s diet is becoming Americanized. America has an obesity problem but that’s also true of many countries in Europe (and indeed China and elsewhere).

    If anything America has a bimodal lifestyle distribution; least a subset of its population is very physically active and health-conscious while admittedly a large fraction is composed of fast-food junkies and couch potatoes. The Brits and others think of us as exercise and health nuts by comparison to themselves.

    I’m not going to speak of America’s social ties, and lack of time from work (which leads to us being a nation of sleep deprivation) but the effect of overweight/obesity on health is probably oversold. A New Scientist article looked into this matter and concluded while obesity has definite health risks associated with it, it’s much harder to find health risks associated with merely being overweight. In fact, overweight people survive health crises and hospitalization better than normal-weight or thin people. The risk associated with being overweight, at least, do not compare with the known and large health risks of smoking and alcoholism.

    As for alcohol consumption, in light-to-moderate doses it’s probably not harmful but not helpful either (the alcohol industry has successfully played its own public relations game much more skillfully than the tobacco industry; they corrupt the science by funding a lot of the studies, there’s been a lot of bad ones playing fast and loose with the data). France’s alcohol problem is so bad enough to be a major depressant on male life expectancy, and that’s probably also true of other European countries. Alcoholism for Russia for men is a health catastrophe.

    My point is, however, is to question arguments that blame the US’s health metrics on lifestyle instead of health care access. What is really awful about the ACA is that a fundamental premise of its cost control strategy is based a simple supply-and-demand calculation, contending that America must have high health care inflation because Americans have it too good and go see their doctor for frivolous reasons. That’s why there’s a tax on so-called “Cadillac insurance plans” even though these are not really any better than what nearly all Europeans have. (Jon Walker of FDL has a better name for them, “teacher plans”, as they are often carried by people of otherwise modest means). Ergo, the ACA seeks to degrade those plans and force all Americans to pay more out-of-pocket every time they receive treatment, to force Americans to see their doctor less and seek medical service less.

    But Americans already pay more out of pocket. They pay more out of pocket now than in they did in the past, and they pay more out of pocket than compared to every comparable developed country. If paying more out of pocket and discouraging people from getting medical services lowered health care inflation then the US would have the *lowest* index, not the *highest*. The fallacy of the ACA is that it’s not American’s utilization of health care services that is the cause of health care inflation (in fact, that is actually *falling*) but the simple fact that getting the same service in the US *cost a lot more than it does elsewhere*. Our MRIs just cost more than their MRIs. And that’s the problem.

    The cause is simply in the nature of for-profit health care. And as such, as that questions the very economic system, it can’t be admitted as such, which is why no one in power questions it.

    -StewartM

  73. Morocco Bama permalink
    July 1, 2012

    Also, don’t forget, insurance companies contract with healthcare providers on what exactly they will pay for any service/procedures they do happen to approve. Here is my own personal example. I just recently had an endoscopy performed. My total out of pocket was $450 that includes an initial consultation co-pay for a specialist of $50, the endoscopy procedure itself to which my $350 yearly deductible applied, and the final follow-up visit to discuss results of which another $50 copay applies. The gastroenterologist billed the insurance company for all of this as follows:

    Initial Consultation: Billed – $248 Reimbursed – $169
    Endoscopy Physician Fee: Billed – $700 Reimbursed – $253
    Anesthesia: Billed – $900 Reimbursed – $159
    Anesthesia: Billed – $810 Reimbursed – $159
    Follow-up Consultation: Billed – $248 Reimbursed – $169

    So, from that you have the following breakdown:

    Total Billed: $2906
    Patient Paid: $450
    Ins. Paid: $950

    And keep in mind that this coverage is $6000 per year in premiums. When you include deductibles of which we never meet because we go to the doctor so infrequently, and copays, our total out of pocket can exceed $8000 assuming insurance doesn’t reject services and/or procedures. With ACA, I expect that yearly amount to increase, not decrease, and I expect means testing to be so strict that only the poorest of the poor will qualify for subsidies. This legislation, for those already living on the margins, will drive many to the poorhouse in the years to come, and will only serve to make the rich, richer. Same as it ever was…..same as it ever was.

    PS: Not sure why there was a double charge for anesthesia and why insurance paid it without questioning it, but I plan on calling the doctor’s office on Monday to get an explanation, and to also get an explanation as to why my total $350 deductible was not applied, and if it wasn’t a mistake, what is the status of my refund for the unused amount. Many people do not follow up on these technical issues. For the responsible and diligent patient, it is a great deal of time to keep on top of what both the healthcare providers are doing and what the insurance companies are doing. The process is not seamless, and if you, as the patient, are not on the ball and on your game, you’re the one that ends up getting caught between the cracks…meaning you’re the one that ends up getting screwed.

    Oh, and by the way, the prognosis of all that. Take some Prilosec and call me in a decade.

    groo, from the outside looking in, don’t you feel that $6000 per year in premiums is enough to cover everything within reason? In fact, don’t you feel it is way too much to pay for everything within reason.

  74. cbear permalink
    July 2, 2012

    THANK YOU! Will the real progressives please stand up, please stand up! This sucks for me! I cannot premium costs for private health insurance currently, but I’m not “cost-shifting” either. But now, I’m just taxed for being poor. And I will not qualify for Medicaid as it is presently structured. That’s bull. There’s no “CHOICE” when I cant’ afford insurance. Medicaid expansion is “optional” i.e. underfunded or gone. It’s pointless voting. Obama is a fake who will drive us all off the cliff into greek-like receivership while f*ing over the poor and Romeny is a walking nightmare. OMG. I give up.

  75. July 3, 2012

    My late grandfather was a Muslim Indian immigrant to Pakistan at the time of Partition, and very firmly bourgeois. Meaning, then as now, he wasn’t that rich by Western standards, but astronomically better-off than the rest of the Pakistani population. And also, class is a somewhat separate category from literal wealth in those societies—associated, but only loosely.

    In his last years when I was quite young, he visited us in Canada in the winter—you can imagine how foreign a Canadian winter would be to him—and he slipped and fell and broke a bone. Fortunately, we had bought private insurance for him, since, as a non-Canadian-resident he would not have qualified for Canadian health care in any case. Nevertheless, the hospitals available at the time were all public hospitals, and so he was treated there, to pretty good care.

    However, he had a whole lot of trouble wrapping his mind around the fact that the hospitals were full of, well, labourers and people that, back home, he would have considered lower-class. Oh, he didn’t begrudge them the care itself (he was involved in charity work to bring modern health care to poor people), it just didn’t fit with his mental model of the universe that they would be served in the same environment as him, and he would share facilities with them. Clearly, there was something wrong if his class status shouldn’t be able to buy him separate facilities.

    This was an attitude reinforced by some of his experiences during the decolonization of Pakistan. The upper classes of Pakistan (and India) had been subsidiary to the British long enough that the British had inculcated ways of talking and thinking about things that persist to this very day, even after those attitudes had apparerently disappeared from the UK itself.

    My grandfather had worked a good chunk of his life in a subsidiary to a British company, that was for a time after Independence and Partition led by a good ol’ fashioned English schoolboy—who eventually left when the company was spun off to local owners. But he was around long enough to witness the establishment of the NHS from afar.

    Apparently, this is something like what he told my grandfather at the time: that the establishment of the NHS was when the British people had finally lost all their self-respect.

    And apparently, my grandfather took that to heart. My impression had always been that he admired what Canadians had accomplished, but could never really accept the underlying premise of it.

    The memes that underlie this belief were and are a little incomprehensible to me, especially being born and raised with the idea of single-payer health care, and the idea that I would never go without state-of-the-art medical assistance, no matter that a construction worker sat in the Xray machine before me.

    But these incomprehensible memes are alive and well in the American body politic—among developed countries, the USA is where this belief is now by far the strongest. Yes, the British upper class kind of wishes for the good old days and has been going to some efforts to bring them back, but it has to be done in an underhanded sort of way The USA is the only country where people will dress up in ridiculous costumes and cry hysterically to prevent possibly their own family members from accessing decent health care.

    That’s basically why Obamacare is Obamacare.

  76. July 3, 2012

    Thought-provoking, @Mandos.

  77. groo permalink
    July 4, 2012

    Mandos,

    interesting.

    Maybe two somehow disconnected points:

    –Rich (Saudi, Kuweiti) Arabs are sort of medical tourists in the west, driviing prices up for ‘elite’ medicine.
    On a statistical level this is insignificant, but it drives up prices, if there is a written right, that everybody has has the right for the best possible treatment… and eventually ruins a (healthcare) system, or it devolves into a two-class system, where the ones get their treatment, which is denied to the other.
    One of my relatives has a difficult sort of Multiple sclerosis, which costs 2k€/month only for the pills, for the rest of his life.

    –…and the idea that I WOULD NEVER GO WITHOUT STATE-OF-THE-ART MEDICAL ASSISTANCE, no matter that a construction worker sat in the Xray machine before me. …

    This I do not understand for several reasons.
    a) The number of CTs in the whole of Italy (50mio) is less than that in the greater-Munich area (3mio)
    Life-expectancy Italy 80.5y (world #13)
    Life-expectancy Germany 79.4y (world #21)
    So one has a difficult time to argue that high-tech medicine by itself is decisive for overall better quality of health.
    I actually refuse being diagnosed with an expensive machine if the probability of detecting something is 0.x%.
    But maybe its just me rejecting something like that.
    As a patient You have to be specific NOT wanting that, because the doctor is obliged to apply the BEST possible diagnosis and treatment, at least when You are properly insured and live in the comfort zone.

    b)…no matter that a construction worker sat in the Xray machine before me…
    Never had the idea that this would make some difference.

    Maybe I misunderstand something.

  78. StewartM permalink
    July 5, 2012

    Groo:

    On a statistical level this is insignificant, but it drives up prices, if there is a written right, that everybody has has the right for the best possible treatment… and eventually ruins a (healthcare) system, or it devolves into a two-class system, where the ones get their treatment, which is denied to the other.

    You’re repeating a right-wing talking point in the US. “Best possible treatment” does not necessarily mean “most high tech”. The problem is that in the US, many people don’t get any treatment until they’ve got problems, because they can’t afford to see anyone.

    It would be interesting to see what the spread in life expectancies of these countries. In the US, it can vary with race/income by as much as 14 years.

    StewartM

  79. groo permalink
    July 5, 2012

    StewartM,

    possibly I do not understand the US-HC-system enough, so I have to evaluate it from an outside perspective:

    In my country:
    Propaganda: “Equal healthcare for all.”
    Reality: “You pay a lot, you get a lot”
    Not such a steep gradient as in the US, I suppose, but nevertheless.

    My personal opinion:
    Both sides -the patients AND the providers of HC are deeply mired in a set of only partially congruent beliefs.
    Resulting in mutual corruption and self-deception.

    Both have to give.

    As a self-identified quite extreme left-winger +hopeful realist I am quite bothered by any accusation promoting rightist ideas.

    Maybe the rightist flavor you seem to notice comes from my conviction that I am environmentalist also, who sees the ‘solution’ in a good retreat, decomplexification, scaling down on all levels, including HC.
    I see, that promotion of ‘scaling down’ aligns with some social-darwinist ideas, which I deeply despise.
    Scaling down in my sense means increasing care, and not increasing fights to solve the issue, which definitely is a rightwing agenda, which definitely would destroy any moderately complex system of co-living.

    This is what bothered me in Mandos’ post, because he seems to approach the issue from the side of an immigrant, expecting the promised land and its promises.

  80. July 6, 2012

    groo: Money spent and life expectancy clearly do not really have a linear relationship, I agree. However, I will definitely say that technological change, even if it doesn’t improve life expectancy, can improve life quality in people with complicated diseases (of whom there are many).

    Anyway, my point focused around this:

    b)…no matter that a construction worker sat in the Xray machine before me…
    Never had the idea that this would make some difference.

    Maybe I misunderstand something.

    This was really the heart of what I was trying to express. Why *should* it matter who used the same health care service that I used, as long as I have fair and reasonably timely access to it?

    And the point is that, difficult as it is for me (and evidently you) to understand, it actually kind of does matter to a perhaps surprisingly large number of people. For most of human history, it was more than just widely believed that some people’s lives are more valuable than others—it was assumed.

    Modern health care under social-democratic principles pays at least lip service to the opposite idea. I finally understood the mentality when I moved to the USA. The mentality is: there should be something different about how the upper classes (or the in-group, or whatever) are treated in something so fundamentally important as health care, or the fundamental and obvious difference between classes is diminshed.

    To me, this is a critical point in understanding the US health care debate. There are a lot of opponents of any health care reform at all. They aren’t just opposed to the ACA or the “individual mandate” or whatever, they’re opposed to anything that further dilutes their perceived status as the fundamental in-group. More imporantly, they’re opposed to anything perceived to be so.

  81. Morocco Bama permalink
    July 6, 2012

    Mandos, I understood your point. It’s a cultural artifact that’s very difficult to not only see from another perspective, but equally as difficult to eliminate once it is recognized from another perspective. India is very much the same way, and it becomes even more complex when you consider the combination of English Class structure with the Hindu Caste System. Most people here have read of it, but the Untouchables are a poignant example of it.

    http://www.youtube.com/watch?v=LD3HrIRPVhw

  82. July 6, 2012

    And I just stumbled upon an illustration mentioned here. It’s someone quoting a post by *sigh* Tyler Cowen stating that we can’t have equal access and we should just accept that poor people are going to die rather than attempt to hack at class difference.

    Standard liber-propertarian cant—I mean, it’s Tyler Cowen—but rarely expressed so clearly by people received in polite company.

  83. July 6, 2012

    You can find the “class privilege” issue illustrated today in the economic assistance offices across the country today. As an ever-growing cadre of formerly “middle class” folk queue up for their unemployment and food assistance services, you can see them furtively glancing about like cats in a room full of rocking chairs.

    Education can be a bitch.

  84. groo permalink
    July 6, 2012

    StewartM,

    ok, now I understand Your point better, and we agree.

    That some people are ‘better’ (or healthier, to stay in the context) than others seems like a truism to me.
    The question is: Why are they? What to do about that?

    Here leftist and rightist conceptions of ‘goodness’ seem to fundamentally differ, which I deem of such utter importance to shed a couple of thoughts here:

    –Leftists basically agree that the game of chance (evolution) is random, and all (sentient) beings are subjected to it. (The nonsentient do not care anyway). Therefore ‘god’, or randomness, is unfair, and we have to do something against it.

    This is one of the reasons why the enlightenment kept ‘god’ out of the equation.

    –Rightists attribute their random advantage eg to ‘god’, which has favoured THEM for a supreme reason, and they prove it, by doing god’s will, whatever the methods. (Protestant ethics). Another one being: If I am ruthless, ‘god’ made me so, and ‘I’ have the right to impose that onto inferior beings. (eg Blankfein)

    The actual battlefield nowadays is mostly blurred or hidden.

    I am very sorry that a blog-comment does not allow to elaborate on that.

    As a remark:
    Jeremy Bentham -the british wunderkind of the 18th century- was very much aware of that, and developed his own formula:

    Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do. On the one hand the standard of right and wrong, on the other the chain of causes and effects, are fastened to their throne. They govern us in all we do, in all we say, in all we think …

    No ‘god’ inside!
    Upon closer inspection Bentham had his problems, therefore Rawls’ Theory of Justice’, right?

    The fervor, with which the Rightists invoke their silly notion of a ‘god’ against science, explains itself by their consistently losing against science.
    Thunder and fire against those worshippers of the golden calf named ‘reason’:
    Their ‘god’ gets more furious by the day.

    Us leftists have to defend our insights against such silliness.

    I plead for a robust response, although it is aginst our -ahem- nature.

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