Supreme Court: Mandate Stands

[henge]

whoever you are you have no business being in this profession. ... corrupt union's ... blind to the financial bankruptcy ... They should be grateful ... I cant even imagine the outrage ... you have no say go screw yourself ... We sacrifice ... bust our asses day and night ... make minimum wage ... take it in the ass hard ... pay thousands of dollars to corrupt boards ... putting yourself at risk by scumbag lawyers ... rape your well being ... letiginous pro-lawyer climate.

So does this mean you won't vote for Obama in November?

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[ahha3289]

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[SurfingDoctor]

Hmmm, lots of comments about reimbursement and salaries and so forth, yet no comments about how good it is that couple millions children get coverage or that you can get coverage if you have a pre-existing condition and so forth. Doctors who don't advocate for patients... well, alright. I suppose medical schools should just take out the Hippocratic Oath if people don't really care about it.

 

[calvnandhobbs68]

Summary from Kaiser Foundation:
"Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5 to 1 ratio) in the individual and the small group market and the Exchange."

"Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HSA current law levels except that prevention benefits and coverage for three primary care visits would be exempt from the deductible. This plan is only available in the individual market."

This link explains the whole law:
www.kff.org/healthreform/upload/8061.pdf

I'm not a fan of the only 1.5/1 ratio for tobacco use though and I think that's BS that they ever put that in. I have no problem making people who smoke/chew pay twice as much for insurance as I do considering tobacco is the leading cause of preventable cancer in the world. Way to lobby hard tobacco companies.

 

[KinasePro]

Insightful forum from the Harvard SPH going on right now:

http://ht.ly/bUGng

The panel is pretty level-headed and objective, and contains thought-leaders from public health and health law (though no physicians).

 

[henge]

Why would hospitals or insurance companies ever lower costs?? They have no incentive to do so.

Why do you think insurance companies and hospitals have no incentive to cut costs? Like just about everyone else, insurers and hospitals like having surplus money. Many insurers and some hospitals are for-profit and cutting costs helps maximize profits, which is their goal. Nonprofit hospitals often have management incentive compensation programs that provide for bonuses for cutting costs or increasing the bottom line, and having extra net revenue allows a hospital the opportunity to expand services.

 

[henge]

Hmmm, lots of comments about reimbursement and salaries and so forth, yet no comments about how good it is that couple millions children get coverage or that you can get coverage if you have a pre-existing condition and so forth. Doctors who don't advocate for patients... well, alright. I suppose medical schools should just take out the Hippocratic Oath if people don't really care about it.

 

[Kunu]

Hmmm, lots of comments about reimbursement and salaries and so forth, yet no comments about how good it is that couple millions children get coverage or that you can get coverage if you have a pre-existing condition and so forth. Doctors who don't advocate for patients... well, alright. I suppose medical schools should just take out the Hippocratic Oath if people don't really care about it.

Children are already covered under medicaid. Forcefeeding liberal socialist ideology on the healthcare system isnt advocating for patients.

 

[SurfingDoctor]

Children are already covered under medicaid. Forcefeeding liberal socialist ideology on the healthcare system isnt advocating for patients.

I think you should read the bill if you think the act doesn't improve coverage for children.

"Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents' plans. These are just a few of the law's investments in child health, with many more set to take effect over the next few years as affirmed by today's decision." -from the AAP

There's also expansion for CHIP for families who don't qualify for Medicaid.

 

[Kunu]

Extending benefits to older dependents and reimbursement for chronic illness were covered in some plans already and free market forces may well have selected superior/ more inclusive and fair plans. Both are good and could have been put in place without the legal requirement people buy anything.

 

[crazyozone]

Okay I think you have a problem understanding how this private practice thing works since you've said this more than once. Salaries/Benefits are reported AFTER you've paid everything else out when you're a small business owner. You get paid last. Nobody reports a pre-expense salary...that would just be idiotic since you'd be being taxed on that imaginary salary. Not to mention you could never run an office on a couple hundred grand. Try closer to a million or two once you've taken the salaries of a couple secretaries, nurses, the lease, equipment, lighting, heating, cooling, etc, etc into account.

So a physician who is making 0 dollars because overhead from PP is eating everything would report...0 dollars. He would report benefits for this survey but that comes nowhere close to these mean ranges. So yes, that would be taken into account. Whether they actually respond or not is another matter entirely.

If you read the report you would have seen it mentioned physicians using their own assets to keep the practice going. It's not uncommon for a small business owner to do that.

 

[henge]

Children are already covered under medicaid. Forcefeeding liberal socialist ideology on the healthcare system isnt advocating for patients.

There are more than 8 million uninsured children in the United States.
http://www.childrensdefense.org/chi...data/data-unisured-children-by-state-2010.pdf

U.S. Has 8.6 Million Uninsured Children
http://www.familiesusa.org/resource...es/2008-press-releases/us-has-86-million.html

State eligibility for Medicaid varies, but "the typical (or median) state only covers working parents who make less than 63 percent of the poverty line ($12,790 a year for a family of three) and non-working parents with incomes below 37 percent of the poverty line ($7,063 a year)."
http://www.offthechartsblog.org/health-reforms-medicaid-expansion-is-a-very-good-deal-for-states/

The "liberal socialist ideology" set forth in ACA was originally proposed by the Republican Party's quasi-in-house think tank, the Heritage Foundation, back when they needed to pretend about health care coverage in order to combat Hillarycare.
http://healthcarereform.procon.org/view.resource.php?resourceID=004182

And it was "forcefed" only if you consider passage by a supermajority of the elected Senate, a majority of the elected House and signature by an elected president to be "forcefeeding".

 

[Amnipotem]

.

 

[henge]

Extending benefits to older dependents and reimbursement for chronic illness were covered in some plans already and free market forces may well have selected superior/ more inclusive and fair plans. Both are good and could have been put in place without the legal requirement people buy anything.

Who pays for the extensions? Do you seriously think Republicans would be any less opposed to an expansion of Medicaid than they are to the ACA? Ryan's budget template contemplates cutting Medicaid by about a third as compared compared to the pre-ACA benchline.

I still have a hard time understanding why conservatives are so opposed to requiring free riders to purchase health insurance so that they bear their own costs. And it is a small group of people:

"just 2 percent of the population will face a penalty for failing to get health coverage, according to an Urban Institute study. The other 98 percent either already have coverage, would get coverage under the Affordable Care Act (which would make coverage affordable to many for the first time), or would be exempt from the mandate, the study found."
http://www.offthechartsblog.org/onl...face-penalty-for-not-getting-health-coverage/

 

[NickNaylor]

I can't believe there's been 5 pages bitching about how you will only be paid 200k instead of 400k. No comment on providing healthcare to people. It's pathetic that these are the types of people who are in medical school now.

I'm not in medical school, my girlfriend is, and I know how hard you work. Yet you should also realize that other professions work just as hard, if not more. I thought the difference between us and you was that you actually cared about people and liked what you do more. Apparently most of you are just good liars who lied your way into medical school and don't actually give a crap about helping people. For the record, investment bankers work on average 100 hour weeks and work far more than doctors. I am a lawyer and I work 60 to 70 hour weeks on average and I make less than 200k. So do most lawyers. So quit your bitching. You're not special snowflakes.

Good for you?

 

[Kunu]

There are more than 8 million uninsured children in the United States.
http://www.childrensdefense.org/chi...data/data-unisured-children-by-state-2010.pdf

U.S. Has 8.6 Million Uninsured Children
http://www.familiesusa.org/resource...es/2008-press-releases/us-has-86-million.html

State eligibility for Medicaid varies, but "the typical (or median) state only covers working parents who make less than 63 percent of the poverty line ($12,790 a year for a family of three) and non-working parents with incomes below 37 percent of the poverty line ($7,063 a year)."
http://www.offthechartsblog.org/health-reforms-medicaid-expansion-is-a-very-good-deal-for-states/

The "liberal socialist ideology" set forth in ACA was originally proposed by the Republican Party's quasi-in-house think tank, the Heritage Foundation, back when they needed to pretend about health care coverage in order to combat Hillarycare.
http://healthcarereform.procon.org/view.resource.php?resourceID=004182

And it was "forcefed" only if you consider passage by a supermajority of the elected Senate, a majority of the elected House and signature by an elected president to be "forcefeeding".

None of the republican options threatened penalties on individuals. 0 republicans voted for the affordable care act. Get your facts straight.

 

[Wolverines83]

It's not as bad as you make it out to be. Insurance carriers participating in the Exchanges will still be able to discriminate on certain factors like age or tobacco use, just not as much as they used to. There would also be a cheap catastrophic plan available for people under 30 who decide to go that route, and this plan likely would not cost much more than the tax penalty.

Summary from Kaiser Foundation:
"Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5 to 1 ratio) in the individual and the small group market and the Exchange."

"Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HSA current law levels except that prevention benefits and coverage for three primary care visits would be exempt from the deductible. This plan is only available in the individual market."

This link explains the whole law:
www.kff.org/healthreform/upload/8061.pdf

Catastrophic plans are great for younger people. But, they come with large deductibles. They're designed for people who are basically healthy, don't want to pay large amounts of money in premiums, but don't want to get snagged with a "pre-existing condition" issue if they get sick/hurt. Given that they now have the choice of no insurance until they're sick, it makes much more sense to sign up for a non-catastrophic plan once they get sick to avoid the higher deductible.

They key to that first part is the premium rating area. That's already done with other forms of insurance. Different areas tend to have different lifestyles which leads to more/less healthy population that uses more/less medical care. Certain parts of the country (and certain demographics) are less likely to get preventative medicine...in the long run they're more expensive. That "premium rating area" allows them to pool all people from a certain area into one "risk category" which is great for the sick but bad for the healthy.

Not trying to be argumentative or go tit for tat (wonder if that'll get censored?) here but it's going to be brutal on insurance companies. They make their money from premium dollars from healthy people. They're going to essentially lose their only profitable customers. I'm not claiming it's going to happen in a year but give it a few (I don't know...5, 10, 15, whatever). The only way for the insurance companies to maintain a profit after losing the young/healthy is to overcharge the remaining customers who will then decide it's cheaper to pay the penalty. Yeah it sounds doomsdayish but it's just the insurance market at work.

EDIT: To clarify, I'm not shedding any tears for insurance companies but I do think they serve a good purpose when properly (properly, not overly) regulated (ug...can't believe I'm advocating regulation). I'm nervous about the impact of squeezing out the private sector...which ultimately leads to the government running things....and the government's books are always in order....

 

[The Imprisoned]

Good for you?

+1

Btw, 100 hours a week is not "far more than doctors," but hey it's not like taking care of people's health is important or anything. :sarcasm:

Oh and to add, many comments about salary were coming from an attending physician.

Sent from my iPhone using SDN Mobile app

 

[Amnipotem]

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[ahha3289]

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[SurfingDoctor]

None of the republican options threatened penalties on individuals. 0 republicans voted for the affordable care act. Get your facts straight.

You mean current republicians right, because I recall Ronald Reagan suggested the individual mandate a couple decades ago.

 

[Kunu]

I can't believe there's been 5 pages bitching about how you will only be paid 200k instead of 400k. No comment on providing healthcare to people. It's pathetic that these are the types of people who are in medical school now.

I'm not in medical school, my girlfriend is, and I know how hard you work. Yet you should also realize that other professions work just as hard, if not more. I thought the difference between us and you was that you actually cared about people and liked what you do more. Apparently most of you are just good liars who lied your way into medical school and don't actually give a crap about helping people. For the record, investment bankers work on average 100 hour weeks and work far more than doctors. I am a lawyer and I work 60 to 70 hour weeks on average and I make less than 200k. So do most lawyers. So quit your bitching. You're not special snowflakes.

Please- a lawyer comparing ethics with medical providers?
Commitment to care and compensation are totally separate matters.
I am so sure you would be slaving away "helping" your clients to the best of your professional capacity if you weren't paid.

 

[Dave89]

Some of you come off as extremely self-entitled. "I got into medical school. I deserve a 500k salary even though I have to work *gasp* 60 hour weeks." Grow up. You're still going to make a decent living. But now you might actually have to care enough about what you do to stick with it.

And yes, 100 hour weeks is far more than what most doctors (not residents) work. If you prefer, you could always be a lazy doctor and do family medicine.

Aren't you supposed to be off looking for an ambulance to chase?

 

[Amnipotem]

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[The Imprisoned]

Some of you come off as extremely self-entitled. "I got into medical school. I deserve a 500k salary even though I have to work *gasp* 60 hour weeks." Grow up. You're still going to make a decent living. But now you might actually have to care enough about what you do to stick with it.

Although some doctors may feel a sense of entitlement, many do not. We are not saying that 200k isn't enough to live on (if you even bothered reading the thread). What we are saying is that cutting physicians salaries does very little to save healthcare costs when it makes up 6% of medical spending.

And once again, I respect all professions, however I you are comparing apples to oranges with regards to types of work.


Sent from my iPhone using SDN Mobile app

 

[The Imprisoned]

You clearly didn't read my initial post. Other professionals don't pretend that their number one priority is helping people. I thought doctors did, at least that's what you write in your admissions statement. But I guess this thread demonstrates that that's all crap.

Once again you didn't read what was posted. Doctors do care about their patients. What the 5 pages was about was explaining that cutting their salaries has no benefit to reducing healthcare costs.

Edit: apologies; my post lagged and was posted after yours.

Sent from my iPhone using SDN Mobile app

 

[Dave89]

You mean current republicians right, because I recall Ronald Reagan suggested the individual mandate a couple decades ago.

When Republicans suggested this, I don't think they thought the matter through. (Nor did the Democrats, but they don't care much about the problem I'm about to discuss.)

An individual mandate with a penalty/tax of a couple thousand dollars is NOT a huge deal. But how could it have been passed?

1) Commerce Clause: while I'm aware that liberal law professors basically see this as a wide-open door for the government to regulate anything and everything, this would have set a precedent that under that Clause, the government has the right to create commerce by forcing you to buy a product. Very risky, IMO

2) As a tax. The huge problem with this bill is that the SC basically said the fed govt. can do whatever the hell it wants, as long as it attaches a tax. Clever quote from Tim Carney: "We're not forcing you to put these soldiers up in you home, we'll just tax away your home unless you do."

 

[henge]

None of the republican options threatened penalties on individuals. 0 republicans voted for the affordable care act. Get your facts straight.

Then what is this?

‘‘SEC. 5000A. FAILURE OF INDIVIDUALS WITH RESPECT TO
HEALTH INSURANCE.
‘‘(a) GENERAL RULE.—There is hereby imposed a
tax on the failure of any individual to comply with the
requirements of section 1501 of the Health Equity and
Access Reform Today Act of 1993.
‘‘(b) AMOUNT OF TAX.—The amount of tax imposed
by subsection (a) with respect to any calendar year shall
be equal to 120 percent of the applicable dollar limit for
such year for such individual (within the meaning of sec
tion 91(b)(2) and determined on an annual basis).

SEC 91(b)(2)
‘‘(A) IN GENERAL.—The applicable dollar
limit for an employee for any month is equal to
1⁄12 of the average premium cost for the cal
endar year of the lowest priced 1⁄2 of standard
packages

pages 215-216, 139 of Health Equity and Access Reform Today Act (SB 1770) sponsored by Sen John Chafee (R-RI)
http://healthcarereform.procon.org/sourcefiles/senate_bill_1770_1993.pdf

 

[Kunu]

You clearly didn't read my initial post. Other professionals don't pretend that their number one priority is helping people. I thought doctors did, at least that's what you write in your admissions statement. But I guess this thread demonstrates that that's all crap.

I read your post fine. Patients are the priority and doctors should be fairly compensated. The two arent mutually exclusive though you think so.

 

[SurfingDoctor]

When Republicans suggested this, I don't think they thought the matter through. (Nor did the Democrats, but they don't care much about the problem I'm about to discuss.)

An individual mandate with a penalty/tax of a couple thousand dollars is NOT a huge deal. But how could it have been passed?

1) Commerce Clause: while I'm aware that liberal law professors basically see this as a wide-open door for the government to regulate anything and everything, this would have set a precedent that under that Clause, the government has the right to create commerce by forcing you to buy a product. Very risky, IMO

2) As a tax. The huge problem with this bill is that the SC basically said the fed govt. can do whatever the hell it wants, as long as it attaches a tax. Clever quote from Tim Carney: "We're not forcing you to put these soldiers up in you home, we'll just tax away your home unless you do."

Well, I don't pick sides because that usually doesn't really help anything. And pointing out problems without offering solutions doesn't either. I would gladly consider an alternative... but I can't seem to find an alternative that was proposed, just a bunch of political mumbo-jumbo like "well if this plan fails, out plan is to check the numbers"... in "Count with Elmo" I suppose.

And on a historical note, your quote, which I assume is about the Intolerable Acts (more specifically the Quatering Acts) doesn't really represent modern America. Taxation without representation doesn't exist in this country (unless individuals claim they don't like tax, and then complain that they aren't represented even though they voted, which goes along the lines of poor sports)

 

[Mizoodles]

Some of you come off as extremely self-entitled. "I got into medical school. I deserve a 500k salary even though I have to work *gasp* 60 hour weeks." Grow up. You're still going to make a decent living. But now you might actually have to care enough about what you do to stick with it.

And yes, 100 hour weeks is far more than what most doctors (not residents) work. If you prefer, you could always be a lazy doctor and do family medicine.

Do you have reading comprehension problems? Let me summarize: This thread has discussed how physician salaries are NOT responsible for rising health care costs, yet are unfairly and **unwisely** threatened compared to other healthcare worker salaries. This is driving the best and brightest away from medicine and into other fields, such as banking or finance. This is about economics.

People can whine all they want about how we need an ideological vision for healthcare, but it won't be sustainable. You cannot compare European/Canadian,blah,blah,blah healthcare delivery systems to our own - you overlook the enormous overall educational and financial differences between us and them

 

[henge]

The huge problem with this bill is that the SC basically said the fed govt. can do whatever the hell it wants, as long as it attaches a tax. Clever quote from Tim Carney: "We're not forcing you to put these soldiers up in you home, we'll just tax away your home unless you do."

The Bill of Rights expressly says you have a right not to have soldiers quartered in your house. The tax you describe is plainly a device to get around an express right granted by the Bill of Rights. The Bill of Rights does not expressly say that you have a right to not have health insurance. I have no problem making a distinction between the two situations.

 

[henge]

You cannot compare European/Canadian,blah,blah,blah healthcare delivery systems to our own - you overlook the enormous overall educational and financial differences between us and them

Can you enlighten us about those "enormous" overall educational and financial differences between the US and every other developed country in the world and why they make universal coverage impossible in the US?

 

[eHombre]

I agree that adverse selection is a concern and that the Exchanges won't work if healthy people don't sign up. That's why it matters how the program is designed.

You brought up younger people and I cited a plan that would be cheap and comparable in cost to the tax penalty. Of course, the high-deductible would be costly if the healthy person had a serious accident or illness. For the reasons you said, it would make more sense for a young/healthy person to pay, say, $250/mo instead of $150/mo and get an insurance plan with a manageable deductible and reasonable co-insurance (e.g., "bronze/silver" coverage).

I think most people who fit your criteria (are over the age of 26, are reasonably healthy, make too much money to qualify for subsidies, but somehow are not covered by their employers) who looked at their options would choose the latter deal. The per-month cost of the tax penalty would be $100-150/mo, and I just don't think most people like paying good money in exchange for nothing at all.

So I disagree that insurance companies will lose out on the healthiest (i.e., most profitable) customers. The individual mandate ("shared responsibility requirement") was designed to prevent this from happening. People have the choice to pay $150/mo out of spite and get nothing, or pay $250/mo and get decent health insurance. Hmm...

Catastrophic plans are great for younger people. But, they come with large deductibles. They're designed for people who are basically healthy, don't want to pay large amounts of money in premiums, but don't want to get snagged with a "pre-existing condition" issue if they get sick/hurt. Given that they now have the choice of no insurance until they're sick, it makes much more sense to sign up for a non-catastrophic plan once they get sick to avoid the higher deductible.

They key to that first part is the premium rating area. That's already done with other forms of insurance. Different areas tend to have different lifestyles which leads to more/less healthy population that uses more/less medical care. Certain parts of the country (and certain demographics) are less likely to get preventative medicine...in the long run they're more expensive. That "premium rating area" allows them to pool all people from a certain area into one "risk category" which is great for the sick but bad for the healthy.

Not trying to be argumentative or go tit for tat (wonder if that'll get censored?) here but it's going to be brutal on insurance companies. They make their money from premium dollars from healthy people. They're going to essentially lose their only profitable customers. I'm not claiming it's going to happen in a year but give it a few (I don't know...5, 10, 15, whatever). The only way for the insurance companies to maintain a profit after losing the young/healthy is to overcharge the remaining customers who will then decide it's cheaper to pay the penalty. Yeah it sounds doomsdayish but it's just the insurance market at work.

EDIT: To clarify, I'm not shedding any tears for insurance companies but I do think they serve a good purpose when properly (properly, not overly) regulated (ug...can't believe I'm advocating regulation). I'm nervous about the impact of squeezing out the private sector...which ultimately leads to the government running things....and the government's books are always in order....

 

[Dave89]

The Bill of Rights expressly says you have a right not to have soldiers quartered in your house. The tax you describe is plainly a device to get around an express right granted by the Bill of Rights. The Bill of Rights does not expressly say that you have a right to not have health insurance. I have no problem making a distinction between the two situations.

OK, you obviously have a slight handicap in imagination, so let me give you this one: we're not forcing you to accept patients with government insurance, we're just going to tax you $5,000 for every non-government insured patient you take.

 

[JackShephard MD]

whoever you are you have no business being in this profession. ... corrupt union's ... blind to the financial bankruptcy ... They should be grateful ... I cant even imagine the outrage ... you have no say go screw yourself ... We sacrifice ... bust our asses day and night ... make minimum wage ... take it in the ass hard ... pay thousands of dollars to corrupt boards ... putting yourself at risk by scumbag lawyers ... rape your well being ... letiginous pro-lawyer climate.

So does this mean you won't vote for Obama in November?

I lol'ed.

I wasn't going to post in this thread anymore but this post was too funny.

If anything this thread has ruined the show Lost for me. Man that was a good show, and now this lol

WE HAVE TO GO BACK!!!!
[YOUTUBE]39BIdOP0D6E[/YOUTUBE]

Hmmm, lots of comments about reimbursement and salaries and so forth, yet no comments about how good it is that couple millions children get coverage or that you can get coverage if you have a pre-existing condition and so forth. Doctors who don't advocate for patients... well, alright. I suppose medical schools should just take out the Hippocratic Oath if people don't really care about it.

Good point!

Children are already covered under medicaid. Forcefeeding liberal socialist ideology on the healthcare system isnt advocating for patients.

Just because you don't see these people or think of them, doesn't mean they don't exist or need our help.

I think you should read the bill if you think the act doesn't improve coverage for children.

"Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents' plans. These are just a few of the law's investments in child health, with many more set to take effect over the next few years as affirmed by today's decision." -from the AAP

There's also expansion for CHIP for families who don't qualify for Medicaid.

As Atul Gawande said yesterday, it's not perfect but at least we're doing something and we can attempt to make adjustments along the way.

Good luck to everyone in this thread. The conservatives, the liberals, those who have called me foolish and naive, good luck. I hope that we can find a solution and that you can achieve your career goals.

 

[eHombre]

Then what is this?

Oh, the burn...

 

[Kunu]

Then what is this?

‘‘SEC. 5000A. FAILURE OF INDIVIDUALS WITH RESPECT TO
HEALTH INSURANCE.
‘‘(a) GENERAL RULE.—There is hereby imposed a
tax on the failure of any individual to comply with the
requirements of section 1501 of the Health Equity and
Access Reform Today Act of 1993.
‘‘(b) AMOUNT OF TAX.—The amount of tax imposed
by subsection (a) with respect to any calendar year shall
be equal to 120 percent of the applicable dollar limit for
such year for such individual (within the meaning of sec
tion 91(b)(2) and determined on an annual basis).

SEC 91(b)(2)
‘‘(A) IN GENERAL.—The applicable dollar
limit for an employee for any month is equal to
1⁄12 of the average premium cost for the cal
endar year of the lowest priced 1⁄2 of standard
packages

pages 215-216, 139 of Health Equity and Access Reform Today Act (SB 1770) sponsored by Sen John Chafee (R-RI)
http://healthcarereform.procon.org/sourcefiles/senate_bill_1770_1993.pdf

I dont know your link doesnt open and I dont know what page 215 of section 1501 of some 25 year-old bill that never passed said.

 

[Amnipotem]

.

 

[Amnipotem]

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[SurfingDoctor]

But the issue of utmost importance regarding Obamacare is whether Congress even had the power to pass the legislation.

Well if Congress doesn't have the power to pass legislation, what is everyone voting for then? It's their job to pass legislation that a majority of them agree on... though I don't think they know that that's their job.

 

[Amnipotem]

.

 

[eHombre]

OK, you obviously have a slight handicap in imagination, so let me give you this one: we're not forcing you to accept patients with government insurance, we're just going to tax you $5,000 for every non-government insured patient you take.

That wouldn't happen, for obvious reasons. $5k x 1000 private patients = $5 million. It would be unconstitutional for Congress, under the taxation power, to make individuals an offer they couldn't refuse, going by C.J. Roberts' language. The size of the tax penalty under this precedent has to be commensurate with the activity being nudged one way or another. More likely would be a tax of, say, $20 per private patient. That approach isn't great in principle, but it sounds completely different when you've reduced the penalty by two orders of magnitude.

Now, I'm not endorsing that approach; I think the government should use less direct ways of getting doctors to take on patients with public insurance (by, say, raising certain Medicare/Medicaid reimbursements). But I'm just pointing out that your scenario is entirely unconstitutional, and therefore rhetorically moot.

From the majority opinion (page 4):
"Such an analysis suggests that the shared responsibility payment may for constitutional purposes be considered a tax. The payment is not so high that there is really no choice but to buy health insurance; the payment is not limited to willful violations, as penalties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation. . . None of this is to say that payment is not intended to induce the purchase of health insurance. But the mandate need not be read to declare that failing to do so is unlawful. Neither the Affordable Care Act nor any other law attaches negative legal consequences to not buying health insurance, beyond requiring a payment to the IRS."

 

[crazyozone]

I skimmed the thread and the majority of the thread consisted of whining about salaries. Not one mention of patients and how Obamacare will increase coverage to those who can't afford it.

"Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents' plans. These are just a few of the law's investments in child health, with many more set to take effect over the next few years as affirmed by today's decision." -from the AAP

There's also expansion for CHIP for families who don't qualify for Medicaid.

This isn't the only example of someone mentioning increased coverage. It's not a very large point to make anyway since it's obvious that with a mandate more people will be covered. That is why you've seen other things discussed more broadly.

As for skimming the thread and seeing most people "whining about salaries," you should read the beginning of the thread. It actually began with some people demonizing others the same way you are right now.

Just because someone here doesn't want to see their salary reduced doesn't mean it takes precedence over care giving. There are lots of lawyers who get into law because they want to help people too. I don't think they would love to sit by while their annual income gradually decreases. No one wants to lose money; it's been said before that cutting doctor pay won't put a dent in premiums so why should doctors lose money?

Edit: well sorry to get this in after the conversation became more productive

 

[Amnipotem]

.

 

[Wolverines83]

I agree that adverse selection is a concern and that the Exchanges won't work if healthy people don't sign up. That's why it matters how the program is designed.

You brought up younger people and I cited a plan that would be cheap and comparable in cost to the tax penalty. Of course, the high-deductible would be costly if the healthy person had a serious accident or illness. For the reasons you said, it would make more sense for a young/healthy person to pay, say, $250/mo instead of $150/mo and get an insurance plan with a manageable deductible and reasonable co-insurance (e.g., "bronze/silver" coverage).

I think most people who fit your criteria (are over the age of 26, are reasonably healthy, make too much money to qualify for subsidies, but somehow are not covered by their employers) who looked at their options would choose the latter deal. The per-month cost of the tax penalty would be $100-150/mo, and I just don't think most people like paying good money in exchange for nothing at all.

So I disagree that insurance companies will lose out on the healthiest (i.e., most profitable) customers. The individual mandate ("shared responsibility requirement") was designed to prevent this from happening. People have the choice to pay $150/mo out of spite and get nothing, or pay $250/mo and get decent health insurance. Hmm...

Penalty: The annual penalty for not having minimum essential coverage will be the greater of a flat dollar
amount per individual or a percentage of the individual’s taxable income. For any dependent
under the age 18, the penalty is one half of the individual amount.
 The flat dollar amount per individual is $95 in 2014; $325 in 2015 and $695 in 2016.
After 2016, the flat dollar amount is indexed to inflation. The flat dollar penalty is
capped at 300% of the flat dollar amount. For example:
o A family of three (two parents and one child under 18) would have a flat dollar
penalty of $1737 in 2016;
o A family of four (two parents and two children over 18) would have a flat dollar
penalty of $2,085 in 2016 because the 300 % cap would apply.
 The percentage of taxable income is an amount equal to a percentage of a household’s
income (as defined by the Act) that is in excess of the tax filing threshold (phased in at
1% in 2014; 2% in 2015; 2.5% in 2016). For example:
o If an individual has a household income of $50,000, the percentage would be 1%
of the difference between $50,000 and the tax threshold (which is $9,350 for an
individual in 2010). Assuming the tax threshold is $10,000 in 2014, this individual
would be subject to a percentage penalty of $400. Because this percentage
penalty is greater than the flat dollar penalty for 2014 (which is $95), he would
pay the percentage penalty.

These penalties are pennies on the dollar compared to premiums. If I make $50k/year that means my penalty is $33/month. Then I can just buy insurance when I need it (and drop it when I'm done). Specifically, this is going to push middle and lower income brackets (those who are supposed to be the main beneficiary of this law) out of the pool because they have less disposable income.

People are always going to look at what the lower cost is. If my father could have paid $3000/year for insurance for him, my mother, myself and my four siblings, we would have gone on more vacations! Even if it was $5000/year (using the 2.5% rule assuming 200k/year) he would have been thrilled.

 

[The Imprisoned]

Although I disagree that there are "enormous" differences between the US and other developed countries to hinder the development of a functioning universal healthcare system in the US, there is one problem that needs to be dealt with in the US before progress can be made.

One large problem with the US education system is the federal involvement with student loans. Because the federal government has funded unlimited loans to students, universities have increased tuition rates to those 5 times what European counterparts charge. Not to mention, medical school is a graduate program in the US while it's an undergrad program in Europe, so US students are already having to pay for 8 years of schooling, instead of 3 to 4. If medical students didn't graduate with $200k loans, there'd be far less of an issue with a 16.7% reduction in salary proposed by Obamacare. The only solution I see here is mandating a cap on loans, which would decrease tuition rates.

However, through IBR and other loan repayment systems, it is feasible to pay off loans within 10 to 20 years. These might be a temporary solution, but at least something is in place to assist in loan repayment.

I agree that medical school tuition is ridiculous, however this doesn't change the fact that reducing the salaries does very little to reduce overall healthcare spending.

Edit: this is the last time I'm posting about this particular topic. I've come to accept that you are glazing over the same point the others and myself have gone over multiple times.

 

[henge]

I was talking about costs for the consumer. People seem to be under the impression that we will somehow be paying less for insurance because there will be more people contributing to the pot. My point was that an insurance company has no incentive to lower your premium just because more people are chipping in and making it less expensive for the company to cover others. Same goes with hospitals.

OK, that was not how I understood your post. Clearly, insurance companies want to maximize profits, so they have no incentive to cut premiums (the consumers' cost). But there are a few things in ACA that might help.

First, it will be much easier for consumers to shop and compare policies, if only because community rating reduces the number of ways that an insurance company can obfuscate the premiums people actually pay. In my state, BCBS is the only insurer that uses community rating (it's a state law). It is also the only insurer that has a website where you can plug in your age, gender and zip code and get an instant quote that will be what you will actually pay. Add in the systemization of policies (bronze, silver, gold, platinum, each with required characteristics) and you'll be able to shop at home, won't have to get a physical and can get a fixed quote not subject to revision. That will increase competition and put downward pressure on premiums.

Second, once the pre-ACA uninsured have insurance, hospitals will have another source of revenue, which might (not saying will) reduce the pressure they are under to increase prices for other insurers and consumers. Maybe other cuts will offset that, but cuts are coming, ACA or no.

Third, larger pools will, through the law of large numbers, decrease the insurers risk which could reduce non-productive reserves insurers have to keep and which will, if you believe all of that risk-return stuff that the finance people propagate, reduce the return demanded by investors.

No one knows how that will all balance out.

 

[calvnandhobbs68]

If you read the report you would have seen it mentioned physicians using their own assets to keep the practice going. It's not uncommon for a small business owner to do that.

So what? Assets and income are two seperate things. My point is none of reported income is going to overhead..it would have been put into the business BEFORE it was reported as income because you're going to get taxed on that income if you report it.

 

[eHombre]

Penalty: The annual penalty for not having minimum essential coverage will be the greater of a flat dollar
amount per individual or a percentage of the individual's taxable income. For any dependent
under the age 18, the penalty is one half of the individual amount.
 The flat dollar amount per individual is $95 in 2014; $325 in 2015 and $695 in 2016.
After 2016, the flat dollar amount is indexed to inflation. The flat dollar penalty is
capped at 300% of the flat dollar amount. For example:
o A family of three (two parents and one child under 18) would have a flat dollar
penalty of $1737 in 2016;
o A family of four (two parents and two children over 18) would have a flat dollar
penalty of $2,085 in 2016 because the 300 % cap would apply.
 The percentage of taxable income is an amount equal to a percentage of a household's
income (as defined by the Act) that is in excess of the tax filing threshold (phased in at
1% in 2014; 2% in 2015; 2.5% in 2016). For example:
o If an individual has a household income of $50,000, the percentage would be 1%
of the difference between $50,000 and the tax threshold (which is $9,350 for an
individual in 2010). Assuming the tax threshold is $10,000 in 2014, this individual
would be subject to a percentage penalty of $400. Because this percentage
penalty is greater than the flat dollar penalty for 2014 (which is $95), he would
pay the percentage penalty.

These penalties are pennies on the dollar compared to premiums. If I make $50k/year that means my penalty is $33/month. Then I can just buy insurance when I need it (and drop it when I'm done). Specifically, this is going to push middle and lower income brackets (those who are supposed to be the main beneficiary of this law) out of the pool because they have less disposable income.

I take your point and thank you for getting the real numbers for single individuals into the discussion. In your example, though, you only cited the 2014 penalty. By the time it ramps up, the flat dollar penalty ($695) would be greater than the percentage penalty, so the penalty would be $68/mo. That's about the cost of a high-deductible catastrophic insurance plan for a young healthy person. Given the choice of paying $68/mo and getting either bare-bones insurance or nothing at all, people will be incentivized to take the former option.

I agree that the penalty should be stiffer to ensure full compliance, but political considerations prevented that, and it's just as well. As it stands, I think the mandate will still do the job it needs to do, all while not offending Justice Roberts' fee-fees.