Bizarre statements from Romney today. Basically he likes a lot of the individual sections of ACA - except for the mandate. Which is based on Romneycare, which he once upon a time planned to run for president on, not against.

He also called it a "moral failure" for Obama to have implemented his MA policy. And said we must elect him so he can repeal his policy which Obama implemented.

In other news, Michelle Bachman criticized the SC for "judicial activism". This is now apparently defined as NOT legislating from the bench.

Just a weird day.

(06-28-2012 01:25 PM)texd Wrote:  They have to pay the tax if they don't have insurance (starting in 2014). The tax is the same as the "penalty."

So Roberts took their exemptions away? Let's hope that is the case, but somehow I doubt it.

(06-28-2012 01:37 PM)JustAnotherAustinOwl Wrote:  Bizarre statements from Romney today. Basically he likes a lot of the individual sections of ACA - except for the mandate. Which is based on Romneycare, which he once upon a time planned to run for president on, not against.

He also called it a "moral failure" for Obama to have implemented his MA policy. And said we must elect him so he can repeal his policy which Obama implemented.

In other news, Michelle Bachman criticized the SC for "judicial activism". This is now apparently defined as NOT legislating from the bench.

Just a weird day.

The only way Romney's statements are bizarre is if you assume that he has some philosophical basis for making them. His support of a government-run medical care scheme as governor was a political decision designed to preserve his status and power. The only factor in his decision to now oppose the exact same scheme is that he sees it as the best strategy to regain status and power. In this context I see absolutely no inconsistencies in anything that he has said.

(06-28-2012 02:53 PM)Tomball Owl Wrote:  

(06-28-2012 01:25 PM)texd Wrote:  They have to pay the tax if they don't have insurance (starting in 2014). The tax is the same as the "penalty."

So Roberts took their exemptions away? Let's hope that is the case, but somehow I doubt it.

What exemptions are you talking about? These are the only exemptions to the mandate/penalty:

 individuals with a religious conscience exemption (applies only to certain faiths);
 incarcerated individuals;
 undocumented aliens;
 individuals who cannot afford coverage (i.e. required contribution exceeds 8% of
household income);
 individuals with a coverage gap of less than 3 months;
 individuals in a hardship situation (as defined by the Secretary of Dept. of Health &
Human Services (HHS));
 individuals with income below the tax filing threshold; and
 members of Indian tribes.

So to be exempted you have to be poor, undocumented, incarcerated (thus cared for by the state), Native American (in which case you're probably taken care of by the IHS), short-term uninsured, or Christian Science.

(06-28-2012 04:52 PM)texd Wrote:  So to be exempted you have to be poor, undocumented, incarcerated..., Native American..., short-term uninsured, or Christian Science.

Geez, some people get all the breaks!

(06-28-2012 04:52 PM)texd Wrote:  

(06-28-2012 02:53 PM)Tomball Owl Wrote:  

(06-28-2012 01:25 PM)texd Wrote:  They have to pay the tax if they don't have insurance (starting in 2014). The tax is the same as the "penalty."

So Roberts took their exemptions away? Let's hope that is the case, but somehow I doubt it.

What exemptions are you talking about? These are the only exemptions to the mandate/penalty:

 individuals with a religious conscience exemption (applies only to certain faiths);
 incarcerated individuals;
 undocumented aliens;
 individuals who cannot afford coverage (i.e. required contribution exceeds 8% of
household income);
 individuals with a coverage gap of less than 3 months;
 individuals in a hardship situation (as defined by the Secretary of Dept. of Health &
Human Services (HHS));
 individuals with income below the tax filing threshold; and
 members of Indian tribes.

So to be exempted you have to be poor, undocumented, incarcerated (thus cared for by the state), Native American (in which case you're probably taken care of by the IHS), short-term uninsured, or Christian Science.

I am now known as Big Chief Firewater WMDOwl

I was referring to exemptions to the mandate given to certain businesses, union groups, etc., many of which were in Pelosi's district, not to mention Congress themselves, in the weeks after ACA was passed.

Actually Congress wrote themselves out before passage.

(06-28-2012 06:05 PM)georgewebb Wrote:  

(06-28-2012 04:52 PM)texd Wrote:  So to be exempted you have to be poor, undocumented, incarcerated..., Native American..., short-term uninsured, or Christian Science.

Geez, some people get all the breaks!

This made me chuckle. And let me say, leave it up to the Rice Board to have a discussion about ACA based on ACA itself and the actual reasoning found within the SCOTUS opinion. Against it or for it, that's all I ask from people discussing contentious issues like this.

Unless the entire law was thrown out, I know Obamacare made my middle class taxes go up. My family gets employer-provided health care, so it's not a issue. However, with just the limitations enacted on Health Care FSAs in the statute to just $2500, I don't get that break any more on anything above that (and we are always above that). A very direct example that definitely affects many below that supposedly magical $250k no-tax line.

And best I can tell, none of the other parts of the law accrue to my (or my family's) benefit.

And wasn't 2012 the first year (or is it next year) when the annual costs will actually be higher than the revenue generated (or tax benefits foregone), even in the most optimistic of CBO ratings? Definitely not cost neutral.

I wonder what Mittens thinks of this statement now:

Quote:As president, Mitt will nominate judges in the mold of Chief Justice Roberts...

(06-28-2012 10:02 PM)gsloth Wrote:  And best I can tell, none of the other parts of the law accrue to my (or my family's) benefit.

That could change, for instance, if you were to face a pre-existing condition situation in the future.

(06-28-2012 10:02 PM)gsloth Wrote:  Unless the entire law was thrown out, I know Obamacare made my middle class taxes go up. My family gets employer-provided health care, so it's not a issue. However, with just the limitations enacted on Health Care FSAs in the statute to just $2500, I don't get that break any more on anything above that (and we are always above that). A very direct example that definitely affects many below that supposedly magical $250k no-tax line.

And best I can tell, none of the other parts of the law accrue to my (or my family's) benefit.

I think everyone I know who has good employer provided insurance sees no reason to change. For those of us buying individual insurance the picture is a lot worse. To give you an idea, we are looking forward to Medicare, as our costs will go down significantly and the coverage will be about the same (bad).

While it may not benefit you today, circumstances change. What if you stop working for a company that provides coverage? Or your children want to stay on your policy after college?

While I think the ACA has many flaws, and is not what I would have wanted, it seems to be better for alot of us and our kids than what we have now.

It is unfortunate that the Republican response is to schedule a meaningless vote to repeal the law, instead of coming up with a list of ways to, you know, actually improve it if it has flaws. (I am the first to say I have not looked at most of the details, many of which do not probably apply to me right now).

I cannot imagine any possibility that my personal health care situation will improve under ACA. I expect to pay more for worse health care , and I expect to become a medical tourist in the event that I need anything major.

A medical tourist where? I ask not rhetorically, but earnestly.

Also, I don't profess to know much about ACA, but it is my understanding that it was anti-insurance companies in many ways. Insurers could not deny applicants who had preexisting conditions, they could not put caps on benefits, etc. To counterbalance all this, the law makes people (who can afford insurance but choose not to insure themselves) buy insurance or pay a penalty/tax, so when they get sick and impose on the healthcare system, they will either have insurance or they will have put money (via the penalty/tax) into the pool such that they impose less on society. As I understand it, then, the mandate was the other side of the coin to the doing away with preexisting-condition denials. Otherwise, if there could be no denial for preexisting conditions, people would just wait until they got sick and then bought their insurance--clearly financially untenably for the insurance companies. Now, I get that one could disagree with requiring insurance companies to cover people with preexisting conditions, but I'm generally not sympathic to insurance companies.

I do feel that ACA gets rid of a certain free-rider problem when it comes to healthcare: people who don't buy insurance but get sick and impose on the healthcare system. I know people say that they will never need or use healthcare, but that's hard for me to believe. If I see you having a heart attack (more likely if you've never seen a doctor your whole life), I'm calling 911 and an ambulance is coming to pick you up, and you're going to get treated. That will cost a lot of money, and if you can't or won't pay, then society bears that cost. Now, I also get that there is the argument that those people ought not to receive emergency treatment (I guess the EMS dispatcher confirms you can pay before the ambulance drives over), but, as a policy matter, I think it's a tough position to take that these people should not receive treatment.

If any of the above misconstrues or misrepresents what ACA does, I apologize, and I'd love to hear the ways that my understanding is incorrect or subject to a different interpretation. Also, the above is a policy discussion, not the legal discussion of whether the Commerce Clause or the federal government's taxing power forms a proper basis for the law. I happen to think it does, but that's another discussion altogether.

(06-29-2012 01:54 PM)Barrett Wrote:  A medical tourist where? I ask not rhetorically, but earnestly.

Most likely the same places the Brits do--France and India. I'm taking counsel with my British friends to learn how to get around the system. I actually have a doctor-selection form from a French medical practice on my desk right now. I was not going to complete it until the court ruled, now I'm undecided. I think I'm going to wait as this is still premature. I am certain that based upon the experiences of close friends in places like Canada and UK, I have no interest in trying to work within the system that we are going to have here. I strongly recommend that anyone who has the means to get outside this system do so.

Of course, I have heard ideas about medical practices basing themselves on cruise ships in international waters, and even one proposal to recycle used offshore oil platforms, so it may not be time to give up on the US just yet. When Richard Nixon gave us the 55 mph speed limit, we learned how to use CB radios, so I do have some hope that Americans will find unique and effective ways to triumph over the system.

As for your understanding of the act, I think you are on track regarding the interaction of the mandate and the pre-existing condition "free rider" problem. That's probably the best part of the act, and if were truly just that, or even truly just Romneycare, I would feel confident that we could make it work. But even Romneycare is only 100 pages while Obamacare is 2200 pages, and it's what's in those other 2100 pages that concerns me.

When the impetus to cut costs hits, it's going to mean reduced access and poorer quality. Even CBO agrees with me on this, in their letter to Harry Reid where they say it would reduce the deficit. There is nothing in this act that will lower costs in any material way--except using the powers of the CCO, HCC, IPAB, and other agencies to force capacity reductions. And that inevitably means reduced access and lower quality. The economics just do not permit a different outcome.

I think Barrett is correct. One of the big positives about the ACA is the pre-existing condions exclusion for insurance companies. Beginning in 2014 you cannot be turned down for medical insurance on the basis of a pre-existing condition. That already applies to children.

The problem with the ACA is that there are so many moving parts and laws and fees and "taxes" that it's hard to keep up with them and to decipher just exactly what they mean in the near and long-term.

From a medical provider view point, the law seems to preserve employer based insurance, for the present. However, if you don't have such a program, or your employer doesn't want to pay for such a program..you then may get dumped into the Medicaid Insurance program. The lawmakers that designed the ACA seem very proud of that fact. Problem fixed..expand Medicaid to cover the un-insured. The problem from a provider standpoint is that a HUGE percentage of physicians don't accept Medicaid. So, if you've got an acute problem..back to the ER for your care. If you have a chronic problem..wait in line at a big clinic. The insurance exchanges are supposed to address some of this. But as insurance companies have to accept sicker and sicker people, the feeling among providers is that more and more people will be driven to Medicaid. Thus the first (intended) step toward universal healthcare and a single-payor system is in place.

Many non-provider type people (patients) are unaware of the slow, but steady changes to how medical care is actually delivered. Declining re-imbursement and changing attitudes about physician life-style are pushing more and more doctors into becoming employees of hospitals and large health care delivery systems. Almost 2/3 of the physicians in The US in 2011 were hospital employees. Actual old-fashion fee for service is disappearing. The ACA puts many programs in place to monitor complications, outcomes and the like. And all of these programs are designed to stimulate the concept of reimbursement on the basis of OUTCOME..not individual fee for individual service. As this process matures and more and more doctors work for hospitals and the like, reimbursement from virtually all sources (Medicare, Medicaid, insurance, etc) will wind up flowing into these large hospital based health care delivery systems. They will budget, apportion and decide physician salaries, nurses salaries and number required, types of services to be offered, who will be hospitalized and who will be treated in-hospital and who will be sent home for care by "mid-levels" (PAs, mid-wives, Nurse practioners) etc. Thus, with hospitals employing Doctors and other providers, they can control costs. More accurately predict costs..and take actions to control costs. ie, ration care.

All of this is already happening to one extent or another. The ACA is just the jump-start for accelerating it. It'll be tweaked. Some provosions will be repealed or changed. But, in my opinion, even if we have a Republican triple victory this year, the change in health care delivery is inexorable. There's simply not enough money to do it any other way.

(06-29-2012 03:36 PM)greyowl72 Wrote:  changing attitudes about physician life-style

The sociologist in me is curious what you mean by that line?

(06-29-2012 04:28 PM)JustAnotherAustinOwl Wrote:  

(06-29-2012 03:36 PM)greyowl72 Wrote:  changing attitudes about physician life-style

The sociologist in me is curious what you mean by that line?

Thank you JAAO for the question!
Physicians finishing training programs today actually want a life ( can you imagine?) They want predictable hours. Set call schedules. Time with their families. ( This younger generation is going to the dogs!!). Hospital employment provides this. But at a cost.. Somewhat less salary. And, ultimately loss of autonomy. I wouldn't do it. But I'm way out of touch and becoming obsolete. The new physicians expect it.

(06-29-2012 05:25 PM)greyowl72 Wrote:  Physicians finishing training programs today actually want a life ( can you imagine?) They want predictable hours. Set call schedules. Time with their families. ( This younger generation is going to the dogs!!). Hospital employment provides this. But at a cost.. Somewhat less salary. And, ultimately loss of autonomy. I wouldn't do it. But I'm way out of touch and becoming obsolete. The new physicians expect it.

This would actually dovetail pretty nicely with some attributes of the French system. Basically, if a prospective doc agrees to spend so many years (I think 10) working for a salary in the "free" system, then med school is free. Once you work off your indentured servitude in the "free" system, then you are free to move to the "pay" system which operates pretty much like ours now.

(06-29-2012 05:33 PM)Owl 69/70/75 Wrote:  

(06-29-2012 05:25 PM)greyowl72 Wrote:  Physicians finishing training programs today actually want a life ( can you imagine?) They want predictable hours. Set call schedules. Time with their families. ( This younger generation is going to the dogs!!). Hospital employment provides this. But at a cost.. Somewhat less salary. And, ultimately loss of autonomy. I wouldn't do it. But I'm way out of touch and becoming obsolete. The new physicians expect it.

This would actually dovetail pretty nicely with some attributes of the French system. Basically, if a prospective doc agrees to spend so many years (I think 10) working for a salary in the "free" system, then med school is free. Once you work off your indentured servitude in the "free" system, then you bare free to move to the "pay" system which operates pretty much like ours now.

"but if you like your doctor, you can keep him." Seems to me that you would end up with a rolling bevy of inexperienced physicians