After the Victory Lap, More Questions

Now that the Supremes have decided that the healthcare mandate is a tax and therefore legal, a whole new set of questions arise in the ongoing debate. Since I am the idiot in charge of dumb questions, here are a few…

Twenty-six states sued the federal govt. to get out of a hefty new medicaid provision. The court threw them a bone by declaring that part of the law unconstitutional. It seems likely that a majority of those states will opt out of the system. Will the sick and infirm flee to neighboring states where they can get coverage without paying a nickel into the system?

California’s sputtering lower middle class will be obligated to buy health insurance beginning in 2014. Failure to do so will result in a $285 ding in their tax bill, escalating to over $2K in the years ahead. How will that affect voters who are being asked to okay sales tax increases by their local municipalities and the state in the November election?

Although some will no doubt dispute me, doctors I’ve spoken with are planning to retire before the offal hits the occilating fan. There is already a problem finding a doctor willing to endure the paperwork involved in MediCal/Medicare, not to mention the lower fees they will be able to receive. Will future care be relegated to understaffed clinics and the long waits for treatment predicted by Republicans?

This new ruling no doubt enhances President O’s reelection prospects, but will likely hurt the Dem’s chances to re-capture a working majority in Congress. The Prez seems to be happy with using executive fiat to get his way, but how long will it be before that pesky constitution and the courts decide to rein him in?

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36 Responses to After the Victory Lap, More Questions

  1. Todd juvinall says:

    From what I am understanding, there is no understanding. Next on the list of mandates, fat cells. The people have to read the 2700 pages to know what is in them. Then when they finish them, they will need to read the 100,000 pages of implementing regulations. After that, direct burial will take place.

  2. Michael Anderson says:

    I just posted this analysis on Russ’ blog. And I think I first saw it posted by someone on George’s blog (sorry for the lack of attribution): http://www.redstate.com/erick/2012/06/28/im-not-down-on-john-roberts/

    On the croquet course this is called a sticky wicket. And all the players have to go through it now. I love that. The alternative would have been for all the players to pack up their mallets to wait for another day to play. I am giddy that we are still on the course (apologizing in advance for the tortured croquet metaphor).

    • Ryan Mount says:

      It feels like one of those end-of-the-world disaster movies where the protagonists are giving each other high-fives thinking they’ve avoided the asteroid. We did it! Then little Johnny interrupts the celebration as he points off into the horizon. There’s an even bigger one coming.

      The Red State article is right as is this Washington Post article (http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/28/the-political-genius-of-john-roberts/).

      Robert’s is up to something. He extraordinarily bright and shrewd. He’s thinking long term. Or as Mr. Erickson put it, “We’re on poker. He’s[Roberts] on chess.”

      I would caution against too much celebrating. Heck, I’m not even sure what people are so excited (or upset) about. It seems more a “f-you, we won.” Won what?

      • Greg Goodknight says:

        This is only the first salvo, expect it to continue for years or until January 2013, depending on what happens in November.

        There’s room for challenge even just based on this decision. Was the tax (that Obama, Pelosi and Reid were very clear wasn’t a tax and had they declared it so, the bill would not have passed) enacted legally? Is the fact that the bill with the tax originated in the Senate rather than the House (required under the Constitution) arguable? What about all of the volumes of regulations that are only beginning to be written?

        All the inexpensive goodies were frontloaded, like the ability to keep young adult children on your policy. The huge costs don’t start to roll in until a couple of years go by, and if the economy remains moribund, people will not be flush when those medical bills start to come in.

  3. Tony Waters says:

    RL,
    There are many issues in the Obama health care bill to work on, but, don’t worry too much about the lower middle class, or doctors. Much of the lower middle class already has health car through their jobs, and/or qualify for the earned income credit (remember, as the Republicans remind us, the lower middle class are already among the 50% that do not pay any federal income tax right now!).

    As for your doctor friends, you should just wish them a happy retirement. They might want to purchase a membership out at Dark Horse if they want to do something for the local community. The median salary for general practitioners is $150 K, and it goes up from there for specialists See: http://wiki.answers.com/Q/What_is_the_median_salary_for_doctors.

    And there is also no shortage of applicants to medical schools. Somehow, I think we will still have doctors after 2014 whether your friends retire or not.

    Having said that, I do think we are in agreement that Obamacare needs reform already. The Democrats larded the bill with pages of goodies for their friends at big Pharma, the trial lawyers, Wall Street, etc. If the Republicans would highlight these problems rather than trying to take away health coverage from 23-26 year olds, they would do much better, I think.

    • RL Crabb says:

      Much of the lower middle class already has health care through their jobs? You must know a whole slew of LMC workers than those I run with. And the insurance offered to those with pre-existing conditions is very expensive with huge deductibles. No relief there.

      • Tony Waters says:

        “And the insurance offered to those with pre-existing conditions is very expensive with huge deductibles. No relief there.”

        The pre-existing conditions problem will disappear with the adoption of Obama’s plan for theLMC, and everyone else. You are right about the gaps–isn’t his a good reason for the Republicans to get involved and start fixing many of the flaws in the current program? Instead, we are getting futile votes simply to repeal the whole shebang.

        • Michael Anderson says:

          Yeah, those futile votes are pretty futile. Eric Cantor needs to take a powder. Time to move on, folks.

          • Todd Juvinall says:

            No, we need to evaluate since we are not liberal sheeple. Cantor is an excellent representaive. You should tell your friend Maxine Waters to take a powder and let the honest people alone.

      • Greg Goodknight says:

        Time for a quickie…

        RL, if most of the lower middle/upper lower class that you knew were public employees, it would probably seem as if most low income workers have health insurance.

        This is a gift to Romney; Obama was going to be running against the Supreme Court. Now November is a vote on Obamacare and the economy and if Romney wins there may be less acrimony over his SCOTUS nominees, if any.

        For those of you who read The Chronicle, Debra Saunders has an interesting take today.

        • RL Crabb says:

          Obamacare’s savings are based on the influx of money coming to the insurance companies from the 26-50 age group that will bear the brunt of the mandate. This assumes that those kids will have jobs that pay enough to afford the bill, otherwise they will fall into the ranks of the 133%-under-poverty catagory. Not to mention the disposable cash they won’t have to spend elsewhere. Let’s hope that all those jobs materialize.

          • Todd Juvinall says:

            Wait until the working middle class poor sees that deduct from their check stub. Revolution!

        • Michael Anderson says:

          Thanks for the tip, Gregory, I jogged on over to the SF Comical to check it out. I highly recommend everyone read it: http://www.sfgate.com/opinion/saunders/article/Mandate-No-Tax-Yes-Dragooning-No-no-3671506.php

          I agree with the court that the mandate lever is a tax not a penalty, and I also agree that trying to tie state Medicaid payments to PPACA implementation was an “egregious dragooning.”

          However, I don’t agree w/ Ms. Saunders that the dragooning will continue with employers; in fact, I think after 2014 employers will start to realize that it makes better sense to jettison their health care benefits and just provide a subsidy for employees to find the plan (provided by new exchanges) that works best for their families. I agree w/ Gregory that this subsidy should be taxed.

          I would also like to predict that “Obamacare,” having now survived the Supreme Court, will eventually be viewed by the American people as the turning point of health care reform in the US, and will by 2020 be held in the same positive esteem as Medicare and Social Security were held after WWII and in the subsequent decades.

          • Greg Goodknight says:

            It isn’t a subsidy that needs to be taxed, it’s income. That’s money your employer pays you, and it’s free. Whether your health insurance costs $200 a month or $2000 a month, you don’t pay a dime. It might cost you $4000 a month in taxable income to buy the same coverage.

            What a deal, and it all started with loopholes in the tax code and WWII wage and price controls, and politicians (mostly Democrats in Congress) who didn’t want to rock the boat to fix it.

  4. Judith Lowry says:

    Here are just a few good paying occupations in the growing medical field.
    There are Boomers aplenty kids, get your diplomas and dig in!

    Acupuncturist
    Ambulance Dispatcher
    Audiologist
    Cardiologist
    Cardiothoracic Surgeon
    Cardiovascular Technician
    Cardiovascular Technologist
    Chiropractor
    Clinical Laboratory Technician
    Clinical Laboratory Technologist
    Clinical Manager
    Colorectal Surgeon
    Dental Assistant
    Dental Hygienist
    Dental Laboratory Technician
    Dentist
    Diagnostic Medical Sonographer
    Ear, Nose and Throat (ENT) Surgeon
    Emergency Medical Technician
    Emergency Room Physician
    Endocrine Surgeon
    Endocrinologist
    Epidemiologist
    Gastroenterologist
    Gynecologist (OB/GYN)
    Health Information Technician
    Healthcare Administrator
    Hematologist
    Home Health Aide
    Hospitalist
    Infectious Disease Physician
    Internist
    Licensed Practical Nurse (LPN)
    Licensed Vocational Nurse (LVN)
    Masseuse
    Medical Assistant
    Medical Equipment Repairman
    Medical Lab Technician
    Medical Records Technician
    Medical Transcriptionist
    Naturopathic Doctor
    Neonatal Surgeon
    Nephrologist
    Neurosurgeon
    Nuclear Medicine Technologist
    Nursing Aide
    Nursing Home Administrator
    Nutritionist
    Obstetrician (OB/GYN)
    Occupational Therapist
    Occupational Therapist Aide
    Occupational Therapist Assistant
    Oncologist
    Ophthalmic Lab Technician
    Optician
    Optometrist
    Oral and Maxillofacial Surgeon
    Orthopedic Surgeon
    Orthopedist
    Osteopath
    Otolaryngologist (ENT)
    Paramedic
    Pediatric Surgeon
    Pediatrician
    Personal and Home Care Aide
    Pharmacist
    Pharmacy Aide
    Pharmacy Technician
    Physical Therapist
    Physical Therapist Aide
    Physical Therapist Assistant
    Physician
    Physician Assistant
    Plastic & Reconstructive Surgeon
    Podiatrist
    Primary Care Physician
    Proctologist
    Psychiatric Aide
    Radiation Therapist
    Radiologic Technician
    Radiologic Technologist
    Registered Nurse
    Respiratory Therapist
    Respiratory Therapy Technician
    Rheumatologist
    Rolfer
    Speech-Language Pathologist
    Surgeon
    Surgical Technologist
    Trauma Nurse
    Triage Nurse
    Upper Gastro-Intestinal Surgeon
    Urological Surgeon
    Urologist
    Vascular Surgeon
    Veterinarian
    Veterinary Technician
    Veterinary Technologist
    Yoga Therapist

    • gregoryzaller says:

      Good point, Judith. No other field has such promise. The glass is almost full and definitely not partly empty. That argument should be dropped.

    • Greg Goodknight says:

      The money sloshing around for all of those occupations will not increase under ‘universal healthcare’, assuming Obamacare lasts past January.

      Having seen them in action, I’d have to say respiratory therapy techs are one of the worst abuses of the system. An AA degree from your local JC and you can slowly walk around a hospital and kibitz while you wait for the patient of the moment to breathe in the meds you’re delivering. A nice $50K on average. And it’s separately billed to the patient.

      • Michael Anderson says:

        PPACA has provisions to fix abuses like this.

        • Todd juvinall says:

          Page numbers please.

        • Greg Goodknight says:

          It could be fixed by a simple jiggering of the definition of independent contractors. For an example, I’d point to the circa 1980 changes in the tax law that made it nearly impossible for engineers to be contractors rather than salaried employees.

  5. Judith Lowry says:

    Just a question here.
    How is mandatory health insurance much different from mandatory auto insurance?

    • Greg Goodknight says:

      Mandatory car insurance pays for some or all of the damage your actions cause to someone else’s person or property. It doesn’t pay for your regular oil changes, chassis lube or engine surgery. It doesn’t fix your car if you break it.

  6. Todd Juvinall says:

    Totaally different. Auto driving is defined as a privledge, able to be regulated.

  7. Judith Lowry says:

    But being seen and treated by a physician is also a privilege, wouldn’t you say?

    • Todd juvinall says:

      You make my point.

      • Judith Lowry says:

        I suppose so.
        Medical services is a privilege and an expensive one.
        If you are certain you will never need surgery, and if you can absolutely guarantee that your life will be illness and accident free, then you should be able to skip the insurance.
        Otherwise, if you do have an accident like say a broken leg, as an acquaintance of mine did, and it cost $45,000.00, like his did, the thing to do, obviously, is to simply to pay for it out of your savings account.
        Of course, if you are really tough, you might consider doing as Inez Ramirez did, perform your own surgery. In her case, a C-section.
        No doctor, no bill, no problem.

        http://listverse.com/2008/12/09/top-10-incredible-self-surgeries/

        • Todd juvinall says:

          Please review the definition of “insurance”. I think there is a misconception on what it is. If you want a mandate to force you to buy it from age 18 onwards, then you don’t really have “insurance”. You have a required mandate which you will pay regardless. So those young people, the one’s who are not in need of “insurance” will be forced to pay for our healthcare via “insurance” forced down their throats.

          Using the logic of the Obamacare law, and the ability to force us to buy “insurance” (and from the hated insurance industry) Congress can now, with this precedent (made from whole cloth) force Americans to buy any product. This is just the beginning.

          • Judith Lowry says:

            The new law says medical insurance is now a tax.
            You carry insurance on your car I assume, and your home, especially fire insurance where we live, right?
            At my age I carry health insurance, and it costs too much if you ask me, it’s a real burn.
            But if I don’t take responsibility for my medical insurance and I do get sick or injured then is it right to expect someone else to pay for my care?

          • Greg Goodknight says:

            No, the insurance cost isn’t a tax. The penalty the IRS extracts from you if you have not purchased the insurance SPECIFIED in DETAIL with no choice is a tax.

            This isn’t “insurance”, it’s prepaid medical care, and you can’t opt for a high deductible policy without frills.

        • Todd juvinall says:

          It is a choice to be insured unless you have a debt you must repay to a car loan or a house loan where they require you to carry it. Of course you don’t have to own a car or a house and if you own them outright it is your decision whther to buy insurance. Obamacare says every soul 18 and up will be forced to pay for you and you and they have no choice. The overarching issue is not our health but the government finding a way to now tell you, under force of the IRS, that you must turn over your health (body) to them because they have the power.
          Insurance companies have been pretty quiet through all this because they are the winners here. They will get trillions of dollars now that Obamacare mandates you to buy their product. This was the greatest ropa-dope perpetrated on Americans since the beginning.

        • Greg Goodknight says:

          Is getting your house painted or your car repaired a right or a privilege?

          You can’t live without buying food. Should grocery shopping be handled the same way health care? Go to the market, no prices on the shelf, tell the nice lady what you want, you take it home and then weeks later you get paperwork showing how much the insurance company was billed, and a few days or weeks later a statement of the insurance company telling you what they paid, what was disallowed and how much you owe the market?

          How well would that work? Would either you or your dog and cat eat differently than now?

  8. Judith Lowry says:

    Under that logic Todd, if you uninsured, home -owning neighbor accidentally burns down his property and yours with it. He owes you nothing.
    If he suffers a seizure and drives his truck into your car and you end up in the ICU, he owes you nothing.
    Wouldn’t it be better to have a plan?
    Isn’t this about the increasing need for personal responsibility in our overpopulated world?
    Maybe with that added sense of responsibility folks would be careful to take better care of their bodies, our “vehicles” (if you will forgive the Heaven’s Gate terminology).
    We might begin to learn at age 18, the big “coming of age”, that what we do to and put into our bodies will be reflected in actual dollars and cents, not to mention less suffering with age.
    The next generation might actually drive down their medical costs and aptly be called, “The Healthiest Generation”.

    • Greg Goodknight says:

      If your neighbor burns your house down, the government will help you shake them down for the full cost to replace it and its contents. They are civilly liable, and, if they have a mortgage, they require you to carry liability and fire insurance just for such an occasion.

      If you have fire insurance, your insurer will pay up to the limit of your policy and then go after the other guy.

      Sorry, but there is NO precedent in US civil law that is similar to what is being done in the name of health “insurance’.

    • Todd juvinall says:

      If you own your home outright and decide not to insure and he burns your house down you sue him civilly if he doesn’t want to reimburse you. Judith, I do not have a problem buying insurance to protect myself from you, what I have a problem with is the government forcing me to buy a product I may not want and forcing my neighbors kids to help me pay it. Nothing in the Constitution allowing that. So when you can’t pay and the IRS comes and liens your property (now that is it a tax) for your bill, don’t say we didn’t warn you.

  9. Judith Lowry says:

    I doubt you would pursue a civil trial with no chance of seeing any money, from someone who hasn’t any. You would be on your own to recover your losses.
    Insurance isn’t exactly a product either, it’s essentially paid protection. Mob-like alright, but there is a certain amount of hard reality to it.
    BTW, your kids are already signed up to care for you when your health ultimately fails. No government mandate, just the tough facts. Alzheimer’s care can reach into the thousands each month. Who knew it would get like this?
    The thing that remains to be seen is if, with this plan, medical expenses become more manageable for the average American household.
    As it is, with the unforeseen possibility of accident or illness, many have the sword of financial ruin dangling over right their heads.
    Enough already, people need relief, let’s try this plan out before we make any calls.

    • Greg Goodknight says:

      If the other guy has a house, even if its burned down, they own property. And you now have a claim on it.

      Yes, before Social Security and Medicare, people did their best to save and provide for their own retirement so as to not be a burden on their kids. Now, the government has stepped in and instead, you are a burden on everyone else’s kids. Progress.

      Save 10% of your earnings and you’d be doing pretty well. Now the effective SS plus medicare plus the income taxes you pay on the SS plus medicare pretending it is income to you and not the greedy geezers (thank you, Alan Simpson), is closer to 20% and it’s likely to be a pauper’s retirement unless you or your spouse also have a public employee pension with perpetual health coverage, unless it’s from Stockton.

      Most people still want Obamacare repealed, and that is not likely to end anytime soon.

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