Thanks for the post, Jon.

These states will serve as the test cases for how much more effective the individual mandate is at encouraging enrollment,

This is kind of bull shit, though. The mandate doesn’t encourage enrollment, it mandates it. That’s why its called a mandate.

Very insightful article Jon. Your are right on target in your premise of the great opportunity to really study and develop understanding of the whole processes of health illness; And as well how to best for a society to function in this area.

My greatest fear and objection to the ACA is that it not only fails to provide systemic solutions but the few things that will work for a while will only cause a delay in developing a lasting program that benefits all..

Excellent analysis, Jon.

One of the things that is going to push states to do something is the financial difficulties of most state Medicaid programs. In NC, even the GOP leadership in the legislature is beginning to worry what Medicaid’s financial problems will do to the long term care industry. Those issues are not going away at the state level. And it impacts the GOP base about as heavily as the Democratic base. Especially in small counties and small towns, where people know their legislators personally.

If this eventuality plays out as your scenario, local and state politics also is going to get very interesting.

The NYT piece about Gruber is amazing. A big part of why we’re in this mess is his ego.

Many states that are blue & purple would opt for SINGLE PAYER like VT ….. No question!

Jon,
I assume this has been discussed at length previously, but I am assuming that the Act has a severability clause so that if only one portion (or several clauses for that matter) is ruled unconstitutional, that the remainder of the Act will stay on the books and in full force and effect. Yes?

slainte,
cl

And if the individual mandate is deemed unconstitutional, what will become of the contraception mandate?

Is it constitutional to force someone to purchase a product or service against their will, whether it be health insurance for themselves or for their employees?

A couple of the more important inconvenient truths is that without the mandate and without price controls the cost of insurance skyrockets; The other and more important, is that if Medicare for all is adopted with its current fee schedule the whole thing will go down like the one horse shay.

This Supreme Court is the Tim Donaghy of referees with it comes to the law. These narcissists will not rule in favor of taking money out of their investment portfolios, nor will any sitting politician in this day and age will make legislation to that effect. Furthermore, the executive branch has proven to be impotent in enforcing any law that may damage their portfolios.

Health insurance is another Wall Street racket tossed on the American public so that some people can profit off the sickness and death of another person.

“Draw them in with prospect of gain, take them by confusion.” Sun Tzu, The Art of War

The health care fight morphed from universal to pubilic option to individual mandate where now the supposed “liberals” are defending a mandate to buy a defective product that creates profit through human suffering. The fascists are winning. Even if the mandate is struck down by itself, the majority of this industry friendly act will remain intact or the industry will revert back to what is was doing prior to the act.

The questions that should be before the court is whether health care is a human right or not and should an industry profit off the misfortunes of others?

An analysis of universal care would have been more instructive.

since contraception saves health care costs so your costs go down not up, I am wondering what the question is

as far as employers, again health care actually saves both you and the employer money, first, health care charges companies far less then they charge individuals, an employer would have to pay far more in wages to make up the difference

and second, you need licenses to run most businesses so play by the rules or don’t play, it’s the businesses own choice

Insightful would be addressing the moral reasonings Obama relied upon to foist this travesty upon the very same Americans who elected him because he promised “HOPE” and “change we can believe in”. Insightful would be to remind voters to hold Obama accountable for corrupt excuse for HCR. Republicans are NOT the problem, the Supremes are NOT the problem. THE problem is whinning for 2+ years aboupt Obama’s corrupt Administration and then, when it’s time to hold him accountable remain silent. For 2 years Dems controlled 3 branches of Gov’t. What did Obama accomplish that warrants his reelection and why is FDL so silent in reminding its visitors?

From you argument I guess you support the individual mandate. Congress can pass laws requiring you to purchase the goods and services it chooses.

You’re welcome to that opinion.

don’t know how you got that from my argument, no I do not support an individual mandate nor does the argument I made for you there

I agree.

Don’t employees earn their employer’s contribution to their insurance premiums the same way they earn their salary or employer’s contribution to their pension? Do you think these employers should withhold a portion of someone’s salary if she is going to use birth control? or if he has a wife who is going to use birth control?

I am opposed to the insurance mandate because it requires people to buy a product from a private entity. I am not opposed to requiring access to legal healthcare procedures, medicines, devices, etc. in a healthcare policy,even though these procedures, medicines, devices, etc. may be purchased from a private entity, because the person who has earned the coverage chooses whether to make the purchase.

This article appeared on Healthcare Renewal website today. I think it shows another aspect of our healthcare dysfunctionality: in essense a pissing match between “titans”!
http://hcrenewal.blogspot.com/2012/04/pittsburgh-experiment-i-caught-in.html

The two items you are disucssing are mutually exclusive items. I don’t think the contraception issue is a “mandate” per se, but simply part of preventative health care which involved a large variety of things including contraception. When you purchase health insurance, you purchase a massive amount of drugs for a massive amount of people that you personally do not use.

That’s exactly right. The insurance companies will simply raise their rates to account for the lost revenue. Insurance would become too expensive for many employers and individuals to afford. In otherwords, back to square one.

The act did not have a severability clause but the Supreme Court hired a lawyer to argue the issue of severing only the mandate. It is a very possible out coming but probably not the most likely

And if the individual mandate is deemed unconstitutional, what will become of the contraception mandate?

Is it constitutional to force someone to purchase a product or service against their will, whether it be health insurance for themselves or for their employees?

What in the world are you talking about?
Point to one place that forces anyone to buy or use contraception.

Offering is not the same as requiring, but you do not seem to be able to grasp that concept.

My point was about mandates, the government requires you to purchase a product or service, whether you think it’s good for you, or will save you money in the long run, or not.

You don’t cite any evidence for your assertions of cost savings. Realized cost savings appears to be inconclusive.

http://www.factcheck.org/2012/02/cloudy-contraception-costs/

ok, got your point, my greater point is, no a corporation is not a person and yes I am for mandates for corporations

I think you might agree with me there but am not sure

Indeed.

Right, the bill originally had a severability clause but Harry Reid took it out (why elected officials would want to play chicken with life tenure judges is something of a mystery).

My kid sister is a doctor, and she about choked on her dinner the other night when I explained that there’s a strong possibility of the Court throwing out the entire bill (among other things, it included a lot of changes already in effect as to how Medicare reimburses hospitals and doctors, hospitals have already restructured their operations accordingly).
Nobody is tracking what the collateral damage would be.

Now there’s a story for you Jon, digging up specific provisions of the bill (unrelated to the mandate or guaranteed coverage, neither of which would go into effect until 2014 anyway) and then interviewing experts as to what effect a full repeal would have on these provisions.

Businesses are not obligated by law to purchase health insurance for their employees.

You have the goods on Reid? Just because he’s the majority leader doesn’t mean that he was the one. Phil Gramm got stuff “accidentally inserted” after a bill was passed and before it was registered for presidential signing.

It could be Reid for all I know. Or anyone in conference.

If only the mandate gets struck down, I think that puts the Obama and the rest of the corporate Democrats in a pickle…corporate Democrats have insisted that Obamacare must fail without the mandate, so which would they choose – letting Obama’s signature issue fail or proving how their corporate legislation is false.

Anyway you put it,even if Scotus,Congress,Senate and Obama say mandate is
constitutional,!it’s not!.Obligation to buy a product from a company for profit is not constitutional,that simple.
And don’t tell me that individual prices in health insurance will go down,
that could be the case theoretically and arit

Actually they are or else they pay a fine – the same as the individual mandate.

Gruber is indeed an egotistical asswad. I heard him on NPR the summer of the big healthcare non-debate and you could tell even then he knew he had it in the bag. He was so arrogant on that program I was astonished. I hope his mandate gets over turned. I’d love to be the one to shove that shit pie into his smug f*cking face!

“Under the new law, employers with more than 50 fulltime workers will not be required to offer health insurance to their workers. However, the employer will have to pay a shared responsibility fee if their employee purchases coverage through a new exchange with the help of a premium tax credit targeted toward middle to low income families. In other words, employers can’t be ‘free riders’ and let the taxpayers pay for the cost of covering their workers.

If the insurance provided by an employer would cost workers more than 9.5 percent of their household income, that insurance is considered unaffordable and workers have a new option: purchase affordable coverage on the new health insurance exchanges, and receive a tax credit to make it easier to get the coverage they need.

Under this scenario, employers would no longer be paying to provide benefits to their employee. Instead, they would contribute up to $3,000 to help support the cost of the tax credit provided by the government.

If the employer provides no insurance at all, and any employee obtains premium tax credits through the new exchanges, the employer would pay a maximum of $2,000 per full time employee.”

It’s complicated, but basically, it’s pay for insurance or pay a fine.

.Obligation to buy a product from a company for profit is not constitutional,that simple.

That has not stood in the way of generations of creating a government whose sole purpose is to enrich for profit companies.

I am still confused on how the mandate for Health Insurance is any different from the mandate on Social Security. The program was a Federal program designed to keep Granny from abject poverty in the 1930s. And it’s done a fine job, and would do far better if the annual income cap were removed and the Congress critters would keep their paws off the fund for other unrelated, unfunded mandates.

But I digress…

I pay into the program for every day I work whether I want to or not. So does my employer. There is no mechanism for opting out. If you’re self-employed, you pay both halves of the contribution. No one asks you if you want to. It’s law and you cannot avoid it.

Certainly, long-term care is not a Federal issue but a States rights issue, yet this program has gone on for more than 70 years with nary a challenge once it went into effect.

So if the mandate for ACA is knocked down, can we expect to see a case made for knocking down the mandate for Social Security?

I’ll wait for the screaming to commence.

You don’t understand the difference between social justice by government and enriching for profit corporations. Not surprising as we have for many years been blending normal government functions into a fascist authoritarian instrument of the rich and powerful. So who can tell?

TS, and only because, probably, there was no long term care market in the 1930s, you may be right.

No screaming here.

Short answer is SS is funded through a (payroll) tax. It’s been deemed constitutional for the government to tax its citizens.

The government stores those taxes the Trust Fund in bonds (which as you point out Congress likes to borrow from). Then the government pays out of the Trust Fund to those who are entitled (bad word).

With the individual mandate, the government passed a law that said you have to go spend your money on a product offered by a private company, or you get a fine.

Same is true of the HHS mandate.

BTW, those who advocate for Medicare-for-all (or single payer) point out that it would be constitutional.

http://fdlaction.firedoglake.com/2012/03/27/reminder-no-one-disputes-the-legality-of-single-payer/

What they’re less willing to point out is the reason is because it would be funded by payroll taxes going from 3% to 20% or some similar number.

We are living in a country that has come to be obsessed that every aspect of human life (and death) must first and foremost provide enormous profit to some private commercial entity. We truly have lost the concept of collaboration for the purposes of serving and enhancing the quality of life for each other. Read today’s Wa Po column by Kathleen Parker. It is on first read a hoot. On reflection it describes what we have come to be — one long episode of Wall Street priapism.

Jon, Thank you,
I’ve spent far too much time under the polar ice cap, and generally disconnected, since 2009. It’s hard to keep track of every piece of legislation Sens. Baucus, Nelson or Reid have subcontracted out to CIGNA, Wells Fargo or Pfizer (for example) to draft for them.
cl

Gosh, this is interesting. For months I’ve been wondering how the lack of severability happened.

I came up with two polar opposite takes on this. It might have been gross incompetence resulting from the urgent pass-the-bill-so-you-can-read-it regime. Or it could have been a sly strategy which has ended up as too clever by half. That is, shake a stick at life tenured Justices, as you suggested. We’ll see.

For the moment maybe it’s time to take a breath. I think one has to consider the synergy between the lack of the mandate’s severability AND the lack of a public option — that synergy is what’s potentially fatal to ACA. Maybe that’s what will open better doors.

The rest of today’s piece deserves respect for the effort, but I think we’re really in uncharted territory and will remain there for many weeks. There are too many moving parts at the moment.

My own hope remains that ACA collapses and opens a door for a more productive fight over a path which will eventually, inevitably lead to single payer.

Well, yes, single payer will cost bigtime.

Yet as far as I know nobody has decreed how that revenue stream has to be obtained. The jump from 3% to 20% payroll tax? Or does the gov’t eventually take the measure of all insurance policies away from the industry plus reconstruct the income taxes, or add in a value added tax, or whatever?

The point is that whatever the outcome healthcare will be paid for by some method or another. It is so right now. How to change the payment regime comes after society decides whether or not, or to what extent, healthcare is a right. Then it’s OK to argue about how to pay.

Given that people (and businesses) would no longer be paying increasingly higher rates to the insurance companies AND not having to pay the excess overhead necessary for the insurance companies to make their profits, my WAG is folks would actually wind up paying less in the long run than they are right now – it just re-directs the cost from the insurance companies to the government and instead of the 30% overhead margin of the insurance companies, fits under the 3% margin of Medicare.

You’ve made this 20% payroll tax statement on several occasions and nothing anyone replies regarding health care cost savings, having younger, healthier people in the Medicare risk pool, the current and projected rise in private insurance premiums, how much of those premiums now do not go to health care, alternate ways of financing besides putting the whole burden on the payroll tax causes you to re-think this number.

Actually you yourself are making the case for having Bush’s Social Security attempt happen but to have Social Security Privatization be mandatory where you’d be forced to hand over your retirement to Wall Street. The same also goes for Medicare, etc. Pay your taxes to the government is vastly different than the government ordering you to shop at WellPoint, WallMart, etc.

If you actually care about Social Security, Medicare, etc rather than crying partisan crocodile tears, you should want the ACA mandate struck down because keeping the mandate lays the groundwork for forcing people to send their money to corporations while the social safety net gets privatized.

There’s been long-term care hospitals since at least Galen, which then influenced islamic medicine. Medieval islamic medicine had what were called bimarestans, which were hospitals where people could check themselves in indefinitely. More recently – but still predating your claim of no long term care in the 1930s – there were sanatoriums, which focused on the long-term care of TB patients before the use of antibiotics was invented.

Be fair.

I rethink the number all the time. You know that, I first calculated on known known payments to current olds, that came to 25% or so. Then used the facts provided in Medicare-for-all sites that came to $8000 per person per year which would be about 30%. I reduced that dollar value by 27% because you pointed out private insurance wastes about 30% while the gov. only burns 3%. You sent me to a site that indicated it could be paid for w/7% income tax, plus 2% payroll tax, plus current taxes, plus…

I give you credit for linking to a site with some info. Most just say UNTRUE, or worse, and run away.

It’s just nice to see people start to acknowledge that it’ll cost money (as maa8722 does in #41). Far too many people thind “single payer” is “free health care”.

In this country until about 1970 and historical examples you give and many others care of the sick and disabled was not considered a profit making venture but a community responsibility. Most care was delivered by low or non-profit entities. Private hospitals that charged for services were community subsidized as necessary to provide for charity patients. There were of course the local taxpayer supported charity hospitals in larger communities.

It was unethical and I think there were legal restrictions for medical care providers and pharmaceuticals to even advertise until,, as I recall, about the 1970s. It was far from a perfect system but we at least knew our mission was to care for the suffering. Until we take that back up as the mission of any system we design rather than how it will impact Pfizer we are going to have this confusing, frightening and really cruel situation that keeps us near the bottom of developed nations in most measurements of health.

We have to address the costs at their source — the enormous profits demanded by Insurance and pharmaceutical corporations; This and the virtual absence of significant taxation on the wealthy. NOT ways to cut benefits and increase revenue by taking from the middle class and poor.

OK, you’re right that you have stepped back somewhat on the cost. Have you yet subtracted out what people who have insurance or their employers will not have to pay?

I don’t know who calls single payer “free health care.” I think sometimes it is opponents – as in “don’t want those other people to have free health care” and sometimes it may be just a manner of speaking – as in free public education, which just means everyone pays taxes, every kid can go to school, not that there is no cost.

I believe France pays 7% with no deductibles.

In the long view, having the whole “healthcare insurance” system implode will certainly strip away the pretense among those with health care coverage through their employers that no reform is required. The reality is that even those with “good healthcare insurance” are getting wiped out by medical emergencies. Having all of the 99% realize that they can no longer afford American “healthcare insurance” when companies finally say “no mas” and drop coverage, may force real reform because at that point, we will all realize that an emergency trip to the hospital is a financial death blow to your family no matter if the patient lives or dies.

I, personally, have already decided and I have relatively good healthcare coverage. I refuse to bankrupt my family. Of course, my health care “provider” probably loves that attitude, they get a big chunk of my payroll every month and I’m never going to use it. Funny how health care companies have turned caring for people into the parasitic destruction of America’s well being, but you have to admit, they are damn good at it.

Health insurance “costs” as marym in IL has pointed out elsewhere is 30%. That includes profit, admin., etc. That’s probably the same for every other company that stays in buisness. Ins. companies take in premiums, take profits, pay overhead, and pay out benefits. After all is said and done, 70% goes to claims, on average. Same with the company that makes wigits. Raw matls. in, labor, profit, overhead, and product out.

I admit, we don’t need health insurance. Nobody had health insurance 100 years ago.

I don’t know how absence of “significant taxation on the wealthy” factors in? Maybe just a legacy rant.

The 30% “cost” for private health insurance (money collected in premiums but not spent on health care) is 3% for Medicare. Medicare doesn’t have to use money for profits, marketing, campaign contributions, lobbyists, and staffs of people devoted to finding reasons to deny claims. We need health care insurance that has as its goal providing access to healthcare, not making money by denying care and spending money on a lot of stuff that isn’t health care. Once again, if you care to respond I leave you with the last word, so we can wrap up this round of discussion.

If you dig deeper, all the sources that used actuarial studies concluded that free birth control saved money. I ran some of those private studies long ago.

Seems folks want to ignore the only profession that is charged with making money via policy provisions – better to hire economists and have states and other “researchers” report on aggregate data over a short term.

I am an actuary, Most studies are private with discussions via one on one meetings between companies, but a few are public (although I do not recall a public one on just contraceptives as a benefit).

Pretending the results are inconclusive is nonsense. The decline in the birth rate does not occur without contraceptives, and use goes down if not part of the plan, causing increased costs to the insurance company. You make more money by offering the coverage.

No – the numbers are incorrect.

mid-sized Group policies run at 85% claims/15% profit and expenses. Large Group like Ford run at 6% under Administrative services only contracts (as would be expected as the ins. co’s do ASO contracts for Medicare leading to Medicare’s 3 to 4% cost).

The individual market – and post Reagan, also the small business market – has aimed for 70% claims/30% profit-CEO bonus – admin cost in most states (some state insurance departments – the conservative more corporate controlled ones – don’t care what the claim ratio is so it drops down – often to 55% – on small businesses and individuals – and as low as 20% on direct mail rip off policies like the dread disease (cancer) coverage some states allow).

Prior to reform of the system in 1998, contributions were 12.8% of gross earnings levied on the employer and 6.8% levied directly on the employee (it’s more complicated since the reforms in ’98).

So really 20%. And the reimbursement is about 70% so there’s generally a 30% co-pay.

I agree. Thanks.

Dig deeper?

The link I provided has a dozen sources and the Obama administration claims its contraception mandate will be “cost neutral” – i.e. “no savings”.

You sound very knowledgeable, so I’ll give you the benefit of the doubt, but like the previous poster, you don’t cite any “sources that used actuarial studies” for your assertions of cost savings.

And I’ll defer to you on insurance company “costs”. You indicate some are at 6%, 15%, 45%, 80%. We’ve been kicking around 30% on average compared to Medicare at 3%. I think that’s close enough for this discussion.