Supreme Court: Mandate Stands

[JackShephard MD]

WASHINGTON -- The Supreme Court ruled today that the Affordable Care Act’s requirement that everyone have health insurance is constitutional. Rulings on whether other parts of the law can stand are expected shortly.

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[SoundofSilver]

Mandate invalid under the commerce clause but upheld as a tax. Roberts joins the liberal wing of the court in a 5-4 decision.

 

[JackShephard MD]

I think it's a step in the right direction. Having everyone chipping in should make insurance more affordable.

 

[Mace1370]

I think it's a step in the right direction. Having everyone chipping in should make insurance more affordable.

You're right, massively expanding spending will make healthcare more affordable.

Wait...

 

[Lysinee]

Plus a $2.6 trillion bill.

You're right, massively expanding spending will make healthcare more affordable.

Wait...

 

[JackShephard MD]

You're right, massively expanding spending will make healthcare more affordable.

Wait...

Yeah, spending more doesn't bring down the cost of things...

Wait, economics 101...

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Starting @ $1,799

 

[eHombre]

Um, just off the top of my head..
(1) Currently healthy freeloaders joining the system => lower premiums.
(2) More preventive care and less emergency care => lower costs overall.
(3) Insurance companies must now devote at least 85% of premium revenues on claim payments, so operations must be streamlined.
(4) Pilot programs in cost control, like accountable care organizations and others, may lead to systemic improvements in health costs.

 

[Rubiconcrossing]

You're right, massively expanding spending will make healthcare more affordable.

Wait...

So what would the GOP do instead to make healthcare more affordable and accessible?

(crickets chirping)

 

[SoundofSilver]

So essentially, this sets a precedent that allows the government to compel citizens to buy or do anything, as long as the penalty for not complying triggers a tax.

A tax penalty of 2,000 dollars or 2.5% of income (whatever is greater) if you do not have health insurance by 2016.

Not saying that the law is "bad" or "good", the huge implications and effects of this act will be revealed over the coming years.

But the precedent this sets for future laws is extremely troublesome in my opinion.

 

[TexasPhysician]

I think it's a step in the right direction. Having everyone chipping in should make insurance more affordable.

The opposite. Also private practice/hospitals will push out this insurance. It won't pay out well. Public facilities will be hit hard. Expect higher taxes for all to pay for more facilities, staff, insurance, etc.

 

[JackShephard MD]

So essentially, this sets a precedent that allows the government to compel citizens to buy or do anything, as long as the penalty for not complying triggers a tax.

2,000 dollars or 2.5% of income tax penalty (whatever is greater) if you do not have health insurance by 2016.

Not saying that the law is "bad" or "good", the huge implications and effects of this bill will be revealed over the coming years.

But the precedent this sets is extremely troublesome in my opinion.

I agree that this power could be abused. Yet, in this situation it seems to be fair and beneficial.

 

[Bigz]

You're right, massively expanding spending will make healthcare more affordable.

Wait...

lol. Once we cut back on the Military Industrial complex you know building fighter jet engines the military do not want etc. we will be fine.

 

[guitarguy23]

So essentially, this sets a precedent that allows the government to compel citizens to buy or do anything, as long as the penalty for not complying triggers a tax.

2,000 dollars or 2.5% of income tax penalty (whatever is greater) if you do not have health insurance by 2016.

Not saying that the law is "bad" or "good", the huge implications and effects of this bill will be revealed over the coming years.

But the precedent this sets is extremely troublesome in my opinion.

I agree. I'll be honest, it blows my mind that the there isn't a more narrow definition of what constitutes a tax. In a roundabout way the government could "tax" me because I don't want to pay for a service. I guess they can get their money if they want it.

Sorry for the rant--I do think the benefits and problems brought on by the mandate remain to be seen. I just enjoy keeping more of the money I earn as a responsible citizen.

 

[osumc2014]

what do you guys think how this ruling going to affect physicians?

 

[SurfingDoctor]

I agree that this power could be abused. Yet, in this situation it seems to be fair and beneficial.

People said the same thing about the Social Security Act after Steward Machine Company v. Davis and Helvering v. Davis (meaning, the abuse of power, taxation, yada yada... its all been said before about 80 years ago)

 

[TexasPhysician]

Neurologist just announced closing his geriatric clinic due to reimbursement costs diminishing through Obama. He is moving to a private hospital - inpatient only.

Huge loss as he was one of a couple neuro docs seeing this under served population.

 

[calvnandhobbs68]

The opposite. Also private practice/hospitals will push out this insurance. It won't pay out well. Public facilities will be hit hard. Expect higher taxes for all to pay for more facilities, staff, insurance, etc.

Why would they "push out this insurance"? You realize we're not talking about Medicaid here right...most of this insurance is likely to be the same types of plans on private insurance exchanges right now. The ACA also sets minimum coverage levels. I'm pretty sure getting paid is better than not getting paid at all.

 

[JackShephard MD]

People said the same thing about the Social Security Act after Steward Machine Company v. Davis and Helvering v. Davis (meaning, the abuse of power, taxation, yada yada... its all been said before about 80 years ago)

The government is obviously a flawed entity but we still have to find a way to make things work.

I think Roberts made the right decision in this case. Good for him. Part of the problem in America is that everyone is so obsessed with being liberal or conservative that nothing gets done at the detriment of society.

Neurologist just announced closing his geriatric clinic due to reimbursement costs diminishing through Obama. He is moving to a private hospital - inpatient only.

Huge loss as he was one of a couple neuro docs seeing this under served population.

Well, everyone is free to do as they please. Completely cutting off the option to take care of a population because of lower reimbursements probably isn't the best thing to do though. According to the 2010 income survey, the average neurologist made 268k annually (25th% 190k and 90th% 413k). It's not like they are family care physicians, I'm sure if he still took care of all those patients he would still earn more than most FM physicians.

Who knows though, I guess everything will settle out and doctors will do what they need to. One thing is for sure, the way we pay for healthcare needs to change in this country.

 

[Rubiconcrossing]

lol. Once we cut back on the Military Industrial complex you know building fighter jet engines the military do not want etc. we will be fine.

But that will eliminate jobs!! derba derba... I love it when the pentagon says we do not want this and representatives still push it through because of defense campaign contributions... no corruption there!

 

[Lysinee]

Don't call it a mandate - it's a tax.

 

[mrmatt]

I agree that this sets a worrisome precedent for the federal government's ability to impose taxes as penalties for not purchasing something.

Do you guys think that enough uninsured people actually will choose to buy insurance now? Can the tax be enforced with failure-to-pay penalties?

 

[Rubiconcrossing]

what do you guys think how this ruling going to affect physicians?

probably should just drop out.. Obama just made being a doctor amount to indentured servitude

 

[SurfingDoctor]

I think reactions of people are interesting... "Oh no, reimbursements are going down" or "Oh no, hospitals are going to run the system" or "Oh no, there is no stopping the government now" or "Oh no, this will cause financial collapse"... okay, I wish I had that crystal ball too, but I guess mine is broken.. indefinitely.

However people have made the same comments about other legislative acts in the past... but we are still here (limping along, but that is not the fault of a single piece of legislation)

 

[Bigz]

Neurologist just announced closing his geriatric clinic due to reimbursement costs diminishing through Obama. He is moving to a private hospital - inpatient only.

Huge loss as he was one of a couple neuro docs seeing this under served population.

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

 

[JackShephard MD]

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

in my post above:

According to the 2010 income survey, the average neurologist made 268k annually (25th% 190k and 90th% 413k). It's not like they are family care physicians, I'm sure if he still took care of all those patients he would still earn more than most FM physicians.

 

[sanityonleave]

probably should just drop out.. Obama just made being a doctor amount to indentured servitude

At first I thought I just missed the sarcasm tag, but then I realized that you're serious. Yay scare-mongering with no factual arguments!

In other news, the word you're looking for is tantamount, fyi, as in "Obama made being a doctor tantamount to indentured servitude."

 

[sanityonleave]

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

I think calling people greedy because they're concerned about reimbursements going down is a bad line of argument to take. If we start tooting that horn, the public (who love to bemoan the "greedy doctors") will be all-too-happy to follow suit and lower reimbursements steadily until we can't even pay back our student loans.

The fact is no matter what you wrote in your application essay to med school, financial security is a concern for everyone who isn't independently wealthy. How much one needs to be financially secure is debatable, but EVERYONE has that consideration in their planning for the future.

 

[eHombre]

Why would they "push out this insurance"? You realize we're not talking about Medicaid here right...most of this insurance is likely to be the same types of plans on private insurance exchanges right now. The ACA also sets minimum coverage levels. I'm pretty sure getting paid is better than not getting paid at all.

+1. Seriously, guys.

 

[Bigz]

At first I thought I just missed the sarcasm tag, but then I realized that you're serious. Yay scare-mongering with no factual arguments!

In other news, the word you're looking for is tantamount, fyi, as in "Obama made being a doctor tantamount to indentured servitude."

If residency spots are decreasing then would it not be a great ideal for those that deem medicine to be '"tantamount to indentured servitude'" to get out. I here the financial fndustry is still hiring and job security has never been better.

 

[JackShephard MD]

I think calling people greedy because they're concerned about reimbursements going down is a bad line of argument to take. If we start tooting that horn, the public (who love to bemoan the "greedy doctors") will be all-too-happy to follow suit and lower reimbursements steadily until we can't even pay back our student loans.

The fact is no matter what you wrote in your application essay to med school, financial security is a concern for everyone who isn't independently wealthy. How much one needs to be financially secure is debatable, but EVERYONE has that consideration in their planning for the future.

I agree that we shouldn't call people greedy. At the same time, all the decisions we make shouldn't be profit driven ("Oh, seeing these patients means me earning less, I'm not taking that insurance anymore. I'm only going to take care of patients that pay me well"). That's not an attitude of service, that's pure profit motive.

Why would they "push out this insurance"? You realize we're not talking about Medicaid here right...most of this insurance is likely to be the same types of plans on private insurance exchanges right now. The ACA also sets minimum coverage levels. I'm pretty sure getting paid is better than not getting paid at all.

+1

 

[calvnandhobbs68]

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

Yeah I think people using this line of reasoning is just hilarious. The only options were 1) Keep making the same amount of money or 2) Completely close your clinic? It's like the articles about insurance companies increasing premiums for college kids because of "Obamacare" and then being extremely vague about what types of provisions exactly are causing this.

This is probably the same type of guy who cries about physician salaries but went to med school for 5K a year.

 

[Bigz]

I think calling people greedy because they're concerned about reimbursements going down is a bad line of argument to take. If we start tooting that horn, the public (who love to bemoan the "greedy doctors") will be all-too-happy to follow suit and lower reimbursements steadily until we can't even pay back our student loans.

The fact is no matter what you wrote in your application essay to med school, financial security is a concern for everyone who isn't independently wealthy. How much one needs to be financially secure is debatable, but EVERYONE has that consideration in their planning for the future.

Yeah really reimbursements will be so low that we cannot pay back our medical school debts. What about this, eventually reimbursements will be so low that no one will want to go to medical school. Stop the fear mongering. If a physician closes his/her practice that serves the needy because of the fear of a potential decrease in reimbursements then he can take his greedy practice elsewhere.

 

[JackShephard MD]

Yeah I think people using this line of reasoning is just hilarious. The only options were 1) Keep making the same amount of money or 2) Completely close your clinic? It's like the articles about insurance companies increasing premiums for college kids because of "Obamacare" and then being extremely vague about what types of provisions exactly are causing this.

This is probably the same type of guy who cries about physician salaries but went to med school for 5K a year.

Exactly. When I hear someone with 400k in debt wanting physician salaries to remain high it makes sense. When I hear Orthopedic surgeons 20 years in making 500k saying they don't think they are compensated fairly (I think only 50% think they are paid fairly according to medscape survey).

There's still a large group of physicians who think medicine = the good life. I think today's medical students are more realistic after seeing/internalizing the debt load.

Yeah really reimbursements will be so low that we cannot pay back our medical school debts. What about this, eventually reimbursements will be so low that no one will want to go to medical school. Stop the fear mongering. If a physician closes his/her practice that serves the needy because of the fear of a potential decrease in reimbursements then he can take his greedy practice elsewhere.

I agree with your points but I don't think it's best for you to call out people as greedy when you don't know their situation.

 

[pkwraith]

So essentially, this sets a precedent that allows the government to compel citizens to buy or do anything, as long as the penalty for not complying triggers a tax.

A tax penalty of 2,000 dollars or 2.5% of income (whatever is greater) if you do not have health insurance by 2016.

Not saying that the law is "bad" or "good", the huge implications and effects of this act will be revealed over the coming years.

But the precedent this sets for future laws is extremely troublesome in my opinion.

It sets a precedent? How about it reconfirms over 200+ years of precedent.

Try 1792 Militia Act for setting the precedent of making all citizens buy muskets.

The government has had the power to do since its creation.

 

[bluv1212]

I agree that the individual mandate may present a dangerous precedent. I hope there are no "Oh ****!" moments down the road. However, It's a good thing to, I believe, from a humanitarian standpoint to increase the accessibility of healthcare in the US. The NY times notes that the mandate will only require a minimum (http://topics.nytimes.com/top/news/...nd_managed_care/health_care_reform/index.html), for the uninsured anways. I currently am paying for my own insurance until i can enroll back onto my parent's plan for my final year of eligibility - It's expensive but not excessive, so I'm hopeful that this act can manage. I don't have full time employment, and my last source of money was student loans. Hopefully, the cost of logistics falls upon the gargantuan health insurance companies that have been draining the life-blood out of our economy since Reagan, and pardons Doctors and taxpayers. Naive? maybe.

 

[auburnO5]

Why the **** are you people so against making money?

 

[GoSpursGo]

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

Yeah I think people using this line of reasoning is just hilarious. The only options were 1) Keep making the same amount of money or 2) Completely close your clinic? It's like the articles about insurance companies increasing premiums for college kids because of "Obamacare" and then being extremely vague about what types of provisions exactly are causing this.

This is probably the same type of guy who cries about physician salaries but went to med school for 5K a year.

Do you know neurologist personally? Do you know his financial situation, or the details of his practice? You guys sure he's at the 50th, or even 25th percentile of income for his profession? What kind of family commitments he has? If not, then maybe you should avoid passing judgement on people you don't know--in case you missed it, it sounds like he was one of the few people around who was willing to see that patient population even under the old system, so clearly the guy WANTS to help that patient population if possible.

I'm not sure ultimately if this law is good or bad long-term. Regardless of what happens, I'm going to find a way to be happy in this profession making whatever I make. But to listen to some of you guys, it's like the only options are 1) Love the law and accept the decreasing reimbursements with a smile on your face, or, 2) You're greedy. You can pat yourself on the back for your shining altruism without arrogantly calling everyone who makes a personal decision greedy.

 

[Acoustic]

I think reactions of people are interesting... "Oh no, reimbursements are going down" or "Oh no, hospitals are going to run the system" or "Oh no, there is no stopping the government now" or "Oh no, this will cause financial collapse"... okay, I wish I had that crystal ball too, but I guess mine is broken.. indefinitely.

However people have made the same comments about other legislative acts in the past... but we are still here (limping along, but that is not the fault of a single piece of legislation)

Seriously. I used to not get super involved in these debates because I felt like there was some part of it that I hadn't looked at, something that I was missing. Something that everyone else knew that made them jump to these conclusions of "oh no we're all going to be broke because everyone has insurance now". Now I'm thinking it's more fear mongering than anything.

It seems pretty clear that this will decrease cost for everyone since there won't be as many "freeloaders" anymore. Taxpayers pay less, hospitals pay less, dude that gets random procedure x overcharged so hospital can recuperate cost of other dude that didn't pay pays less, private doctors get less people skipping on bills... I guess you could make the jump that eventually government will use this to make everyone pay nothing for these services, but this isn't single payer it's expanding private insurance coverage.

Even if you were in medicine for the money, this seems like a way to get more of those dollars.

 

[SoulinNeed]

The reimbursement cuts are coming regardless (and I don't believe there are any in PPACA). At least the mandate will mean more people will have private insurance to help offset the costs. Hospitals and clinics lose massive amounts of money due to not being able to collect on patients who don't have insurance. This will hopefully help end much of that. This helps Physicians, folks, not hurt them.

And Texas Physician, in the pre-med forum you got medicare and medicaid mixed up. In that case, I'm sure your Neurologist had to close down due to medicaid subsidies being cut, which is a STATE issue, due to dwindling state budgets. I doubt Obama had much to do with it, especially in Texas.

 

[Acoustic]

Why the **** are you people so against making money?

Do you know neurologist personally? Do you know his financial situation, or the details of his practice? You guys sure he's at the 50th, or even 25th percentile of income for his profession? What kind of family commitments he has? If not, then maybe you should avoid passing judgement on people you don't know--in case you missed it, it sounds like he was one of the few people around who was willing to see that patient population even under the old system, so clearly the guy WANTS to help that patient population if possible.

I'm not sure ultimately if this law is good or bad long-term. Regardless of what happens, I'm going to find a way to be happy in this profession making whatever I make. But to listen to some of you guys, it's like the only options are 1) Love the law and accept the decreasing reimbursements with a smile on your face, or, 2) You're greedy. You can pat yourself on the back for your shining altruism without arrogantly calling everyone who makes a personal decision greedy.

Seriously, what's so wrong with wanting to make money? It's like people expect our profession to be full of people who will give everything with a smile on their face, and they're evil if they don't. This is the only profession I can think of where its own members demonize themselves for wanting to be successful. Giving up everything is not a prerequisite for being able to help others.

 

[SoundofSilver]

It sets a precedent? How about it reconfirms over 200+ years of precedent.

Try 1792 Militia Act for setting the precedent of making all citizens buy muskets.

The government has had the power to do since its creation.

Read article 1, section 8, clauses 15 and 16 of the constitution. This allows congress the power to "provide for organizing, arming, and disciplining the militia". I can easily argue that compelling citizens to buy muskets as part of a militia is constitutional based on part of the clause I have quoted. To my knowledge, this is not something that ever went to the SCOTUS and therefore was never deemed constitutional under the commerce clause or the power of congress to impose a tax which were the arguments the administration's legal team used to deem the ACA as being constitutional.

Today, it was ruled that congress cannot in fact compel someone to participate in commerce (i.e. buy a product from a private company) under the commerce clause. However, the ruling allows congress to impose a tax if you do not possess insurance (i.e. you face a tax penalty if you do not buy a product from a private company). This is a new precedent.

Again, I'm not criticizing the law. I think the effects of the law will speak for themselves in the coming years and at that point we'll be able to decide whether or not the ACA was a disaster or a remarkable achievement.

 

[calvnandhobbs68]

Do you know neurologist personally? Do you know his financial situation, or the details of his practice? You guys sure he's at the 50th, or even 25th percentile of income for his profession? What kind of family commitments he has? If not, then maybe you should avoid passing judgement on people you don't know--in case you missed it, it sounds like he was one of the few people around who was willing to see that patient population even under the old system, so clearly the guy WANTS to help that patient population if possible.

Nope we aren't sure just like we aren't sure what TexasResident was talking about in the first place. How was he one of the few people around willing to see old people (it was a geriatrics clinic) under the "old system"? Pretty sure they're all covered by Medicare. Medicare comes up for cuts every single year, we just end up band-aiding it every single year. Just because the ACA actually puts some of those cuts in place and changes the payment system to try to keep a broken Medicare system limping along doesn't mean it's "under Obama". Maybe he was actually forced to close it, who knows but trying to blame it on Obama is what pisses people off.

Edit: I'm not against making money for the record. I'm really not. I'm against people blaming the ACA for everything bad they've seen happen since 2010. I'm against people using the examples as above as fear-mongering that suddenly all these poor selfless doctors are going to be absorbed into the evil hospitals. My problem is don't pretend like you're so charitable in one breath because you have this clinic and then close down your clinic for fear of losing money in the other breath.

 

[TexasPhysician]

He can take his greed somewhere else. We all know the average neurologist salaries in 2010 and prior and i think they are doing just fine.

Socialist Russia wants you.

 

[RIPSanto]

Anyone else worried about the exchange programs? I am not trying to start a partisan argument here, just someone please ease my concerns....

Tuition is at an all time high, financial aid is virtually nonexistant and some residency programs are starting to lengthen (e.g. 7 years for gen surg). The way it stands, when current medical students graduate and finish residency, we are going to have substantially higher debt than our predecessors.

State funded exchange programs are going to take over private insurance to a large extent (even CNN mentioned this morning estimated 20 million people we lose private insurance coverage for state exchanges rather quickly). This makes sense, why would an employer PAY for insurance when they can let the state subsidies cover their workers?

And for how this effects physician income? Currently, private insurance companies reimburse physicians at 50-60%, some good ones as much as 70%. Medicaid and medicare (expanded on the ACA, a good thing for sure) only reimburse at 17 and 19% respectively. So, if you see medicaid patients, you can expect to receive 17$ for every 100$ that you bill.

Undoubtedly, the state funded exchange reimbursements will mirror those of the federal programs that already exist (medicaid, medicare) rather than private insurance. After all, most states are broke anyway. I don't see how physician salaries will do anything but decrease (drastically, it seems). Also, it seems that this will eliminate ANY possibility of operating a private practice.

I am not in medical school to become filthy rich. I am just fearful of what the future holds, because, truth be told nobody knows how this will all play out. Any thoughts on this? Is my understanding/logic way off? Can anyone interpret this differently?

 

[kpcrew]

Read article 1, section 8, clauses 15 and 16 of the constitution. This allows congress the power to "provide for organizing, arming, and disciplining the militia". I can easily argue that compelling citizens to buy muskets as part of a militia is constitutional based on part of the clause I have quoted. To my knowledge, this is not something that ever went to the SCOTUS and therefore was never deemed constitutional under the commerce clause or the power of congress to impose a tax which were the arguments the administration's legal team used to deem the ACA as being constitutional.

Today, it was ruled that congress cannot in fact compel someone to participate in commerce (i.e. buy a product from a private company) under the commerce clause. However, the ruling allows congress to impose a tax if you do not possess insurance (i.e. you face a tax penalty if you do not buy a product from a private company). This is a new precedent.

Again, I'm not criticizing the law. I think the effects of the law will speak for themselves in the coming years and at that point we'll be able to decide whether or not the ACA was a disaster or a remarkable achievement.

How is it setting a new precedent when the purchase of vehicle insurance is already compulsory for those wanting to drive a car?

 

[SurfingDoctor]

Seriously. I used to not get super involved in these debates because I felt like there was some part of it that I hadn't looked at, something that I was missing. Something that everyone else knew that made them jump to these conclusions of "oh no we're all going to be broke because everyone has insurance now". Now I'm thinking it's more fear mongering than anything.

It seems pretty clear that this will decrease cost for everyone since there won't be as many "freeloaders" anymore. Taxpayers pay less, hospitals pay less, dude that gets random procedure x overcharged so hospital can recuperate cost of other dude that didn't pay pays less, private doctors get less people skipping on bills... I guess you could make the jump that eventually government will use this to make everyone pay nothing for these services, but this isn't single payer it's expanding private insurance coverage.

Even if you were in medicine for the money, this seems like a way to get more of those dollars.

I just think it is interesting people are very sure of outcomes, that passing "X" leads to "Y". I wasn't aware that most human beings had the ability to predict the future. I guess that's why we didn't have a civil war in the United States...

 

[calvnandhobbs68]

How is it setting a new precedent when the purchase of vehicle insurance is already compulsory for those wanting to drive a car?

I'm not against the ACA but this is totally different. You don't HAVE to purchase a car. You do have to be alive (unless you're dead I guess). The ACA basically imposes a tax for being alive because everyone has to have insurance coverage. It'd kind of be like if we made everyone get life insurance. Totally different ideas.

 

[TexasPhysician]

I just think it is interesting people are very sure of outcomes, that passing "X" leads to "Y". I wasn't aware that most human beings had the ability to predict the future. I guess that's why we didn't have a civil war in the United States...

Obama has a history of increasing spending without positive results. History repeats itself.

 

[GoSpursGo]

Nope we aren't sure just like we aren't sure what TexasResident was talking about in the first place. How was he one of the few people around willing to see old people (it was a geriatrics clinic) under the "old system"? Pretty sure they're all covered by Medicare. Medicare comes up for cuts every single year, we just end up band-aiding it every single year. Just because the ACA actually puts some of those cuts in place and changes the payment system to try to keep a broken Medicare system limping along doesn't mean it's "under Obama". Maybe he was actually forced to close it, who knows but trying to blame it on Obama is what pisses people off.

Edit: I'm not against making money for the record. I'm really not. I'm against people blaming the ACA for everything bad they've seen happen since 2010. I'm against people using the examples as above as fear-mongering that suddenly all these poor selfless doctors are going to be absorbed into the evil hospitals. My problem is don't pretend like you're so charitable in one breath because you have this clinic and then close down your clinic for fear of losing money in the other breath.

That's all well and good, and I agree that it's lazy to blame everything since 2010 on Obama and the ACA, etc, and it's lazy to use anecdotes as the basis for fear-mongering. Frankly, I'm neither in love with nor vehemently opposed to the ACA. It just irks me when the pro-ACA side is so black-and-white in calling the docs who may actually have a legitimate reason for making a business decision based on the new legislation "greedy."

 

[TexasPhysician]

How is it setting a new precedent when the purchase of vehicle insurance is already compulsory for those wanting to drive a car?

Why is it mandatory to wear seatbelts, but not wear a helmet on a motorcycle?