Hobby Lobby & The New Age of Slut-Shaming

Here are the wrong opinions I’ve seen in the earlier Hobby Lobby thread, rebutted. 

“Freebies”

No one is getting anything for free. Hobby Lobby offered employer-based health insurance coverage through private health insurance companies. The employees were free to choose to purchase that coverage. In the end, it was the employee – not Hobby Lobby – who was the contracting party and policyholder.  Hobby Lobby won the right to interfere with a private, legal contract between two contracting parties, neither of whom was Hobby Lobby.  By paying her health insurance premium, the employee received coverage for which she contracted, and this included coverage for certain contraceptives that require a physician’s prescription.  So, on top of the contraceptives not being free, but bought pursuant to a paid-for health insurance contract, this is Hobby Lobby interfering with the doctor-patient relationship.  

“Religious Freedom”

This case was about the extension of a legal fiction – corporate personhood – into human personhood. All of a sudden, corporate entities can have “faith” – something that is impossible, because a corporation doesn’t physically exist. Hobby Lobby’s founders are free to exercise their religion however they want. They are free to reject the contraceptives they find objectionable. They’re even free to use no contraceptives at all. No one infringed on that in any way, shape, or form. But by choosing to participate in the non-faith-based for-profit marketplace, Hobby Lobby should be treated as any other corporate entity. If Hobby Lobby wants to be a church and enjoy the exemptions from laws of general application that offend its founders, then it should have done so. The slope here is ridiculously slippery. 

“1st Amendment” or “Constitution”

This was not a constitutional case. It interpreted a federal regulation as being violative of a 1993 federal statute, which was passed to protect American Indians and their exercise of religion. From the opening of the majority opinion: 

We must decide in these cases whether the Religious Freedom Restoration Act of 1993 (RFRA), 107 Stat. 1488 , 42 U.S.C. §2000bb et seq., permits the United States Department of Health and Human Services (HHS) to demand that three closely held corporations provide health-insurance coverage for methods of contraception that violate the sincerely held religious beliefs of the companies’ owners.

and

Our decision on that statutory [RFRA] question makes it unnecessary to reach the First Amendment claim.” The decision is not based on the First Amendment.

and

Any First Amendment Free Exercise Clause claim Hobby Lobby or Conestoga might assert is foreclosed by this Court’s decision in Employment Div., Dept. of Human Resources of Ore. v. Smith, 494 U. S. 872 (1990).

So, no. This was not a Constitutional case, and nothing was declared unconstitutional. 

“They can buy it themselves”

Yes, they could, but they bought health insurance so that it would be covered.  Health insurance policies cost money, and they routinely cover these drugs and devices. Hobby Lobby subsidizes the premium, but it is not a contracting party. As such, it should have no say over what drugs are prescribed and covered, just like it should have no say over which doctor an employee can see, or what diseases the Bible supposedly says are real or not. The women who work for Hobby Lobby are now treated differently from other women working for other corporate entities, and their options for health insurance prescription coverage are more limited than the policies dictate. Hobby Lobby has now opened the door to businesses micromanaging the terms of other people’s contracts for them, when Hobby Lobby is not a party to the contract. 

“These drugs are objectionable; cause abortions”

No, they’re not. Now, we’re not only legally acknowledging that a legal entity can hold “faith”, but we are buying into that company’s false pseudoscience. The drugs and devices to which Hobby Lobby objected – some IUDs and the morning after / week after pills – are not abortifacients. You might believe they are, but they scientifically are not. The Supreme Court did not only rule that Hobby Lobby’s alleged “faith” overrules federal law, but also succumbed to a faith-based opinion that is rebutted by objective fact. If Hobby Lobby sincerely believes that, e.g., SSRIs are forged by Satan in the hellfire, presumably the SCOTUS would just take that without argument and allow Hobby Lobby to interfere with their employees’ health insurance contracts and forbid them from being covered under the prescription coverage provisions of the policies. Sorry, folks! Hobby Lobby’s God wants you to just buck up and live with your anxiety and depression! 

“This is limited to just this one case”. 

Looks like Justice Ruth Bader Ginsburg was right, and the Courts are now going to be overwhelmed with awful corporate entities suing to not have to provide any contraceptive coverage at all

Business owners who don’t want to pay for their employees’ birth control are ending that coverage after the Supreme Court said they could choose on grounds of religious belief not to comply with part of the health care law. Some owners are already in touch with their brokers in the wake of Monday’s ruling. Triune Health Group Ltd. wants to know how soon it can change its coverage to stop paying for all contraceptives, said Mary Anne Yep, co-owner of the Oak Brook, Ill., company that provides medical management services. “We were ready to go when we heard the decision,” she said. Triune had filed lawsuits against the U.S. government and the state of Illinois because of requirements that they pay for contraception.

So, there you go. Women’s health comes second to a corporate entity’s alleged “faith”. As the American right continues its lurch backwards into what they envision as some pre-Roosevelt golden age, women find their status being relegated to that of a second-class citizens. After all, I don’t see Triune or Hobby Lobby demanding that health insurance contracts for male employees exclude Viagra, which can be used to commit sins. 

Slut-shaming. It’s as American as apple pie, and now endorsed by five males on the Supreme Court of the United States of America. 

The Pre-Obamacare Trainwreck

Obamacare-symbolSome of my friends are conservatives. Shocking, I know. They occasionally post things to social media that are critical of people whom I support, and policies with which I agree. Occasionally, I will argue or even troll, but once in a blue moon, I will try to present a reasonable counterargument that is factual and not particularly argumentative. Rare, but it happens. 

On Tuesday, I saw a post linking to this article. My Facebook friend annotated his post by declaring that “progressives…really do all suck”.  I read the article, which detailed the travails of a single mom trying to buy insurance on the Washington State exchange, and having problems with bad advice and equally bad results. I feel horrible for her and anyone else similarly situated. The new insurance mandate, and the fact that the policies have to maintain a minimum standard of coverage means that some people are paying more, and the subsidy schemes are complicated. 

But it’s the “Affordable” Care Act. Not “inexpensive”, not “cheaper”, not “free” – affordable. But once you argue the semantics, you’ve lost. People’s perception is that everyone’s cost would go down, and whenever this proves not to be the case, it gets blown up into a scandal. 

So, let’s take a step back for a second. The Affordable Care Act – Obamacare – is not what I think is best or perfect for this country, but it’s 1,000x better than the utter trainwreck that preceded it. Here’s what I posted as a comment to my friend’s Facebook indictment of “progressives” in general and Obamacare in particular: 

At some point between 1990 – 2009, the Republican Party decided that universal health care coverage was no longer a societal goal, regardless of how it was to be implemented. When “HillaryCare” was proposed, conservatives pushed as an alternative the model now known as RomneyCare and ObamaCare – a regulated and partially subsidized marketplace of private insurance policies that you are (a) mandated to participate in if you have no employer-based coverage; and (b) meets some minimum standard of what qualifies as “insurance”. 

Now that we have Obamacare, which is a regulated individual marketplace of policies, different in each state, conservatives have not just refused to go along with it, but have actively and passively worked to sabotage it. 

Big laws that do big things aren’t going to be perfect in an imperfect world. Under normal circumstances, we would at least have consensus on “everyone should be insured” as a societal goal. We don’t even have that starting point, so everything else must fail. But even if, hypothetically, Republicans did agree that we should all have decent health coverage, under normal circumstances and in a responsive representative democracy, they would work to help fix problems that arise. This, too, we don’t have. That’s why things that have come up as problematic now have to be amended through regulation and executive rulemaking. 

If the right wanted to present an alternative to Obamacare – which is itself the alternative to HillaryCare – then they should have done so. They never, ever did. All they’ve done is try to block it, then sabotage it when they weren’t done repealing it. Oh, sure they bleat on about “tort reform” and the anti-federalist notion that policies should be one-size-fits-all across the country to enhance “competition”, just like the Telecom act of 1996 enhanced cable TV “competition” and the breakup of Ma Bell enhanced telephone “competition”. Just like the merger of Exxon and Mobil or United and Continental enhanced “competition”. 

In the end, government exists, in part, to fill in the holes that private industry can’t – or won’t – fill. Our private health insurance system in this country is unique in its user-dissatisfaction, physician time-sucking, inefficiency, and waste. It has proven to be almost completely unworkable in contemporary society, and its problems are underscored by the fact that no other country in the world sees fit to implement anything resembling it. 

By the same token, the German, Swiss, French, British, and Canadian models are also imperfect. They do, however, produce better results for far less money – and they do it in a way that satisfies the health care consumer. 

ObamaCare’s lack of situational perfection doesn’t take away from the fact that you no longer face lifetime policy maximums; you can no longer be denied coverage due to a pre-existing condition; insurers can no longer arbitrarily drop you when you get sick and use your coverage; preventive care and immunizations will be free of charge with no co-pay or deductibles; females are treated equally now; myriad consumer protections are put in place to help people appeal adverse insurance decisions. All of these changes are significant – so much so that it’s disgusting that these sorts of things were not implemented before. 

But, you know, glitchy website. 

Yes, I’m disappointed that ObamaCare isn’t perfect. But that disappointment is tempered by my disgust with the pre-ObamaCare status quo. I would much prefer a hybrid NHS single payer system that had public care with private sur-care policies. This will not happen in this country in my lifetime unless it’s proposed by a nominal conservative. In the meantime, have fun pointing out the problems that 1/300,000,000th of the population has with an individual policy under a state-run scheme and not only indict the federal program, but anyone who supports it, as horrible.

The Trainwreck

Obamacare. What a trainwreck. The website is a disaster, and now we learn that 137,000 WNY health insurance policies are going to be canceled. This is why the complete government takeover of healthcare in this country – the socialization of medicine – is such a Kenyan/Mohammedan/Indonesian catastrophe. 

This is what the people who shut down the government say, and want you to think. These are the opinions held by the people who threatened default on our sovereign debt and have worked tirelessly for three years to sabotage health insurance reform in this country. 

The Buffalo News’ Washington correspondent Jerry Zremski wrote an article appearing today, outlining that 137,000 WNY health insurance policies are going to be canceled, in direct contravention of President Obama’s promise that, “if you like your insurance, you can keep it”. 

Cancellations! When you buy a policy on the individual market, you’re buying a 12-month contract, and if the policy doesn’t meet  Obamacare’s bare minimum standards, the insurance company is compelled to cancel it. It can offer you a new policy, or you go to the New York health insurance exchange and shop around for something else

Obamacare’s promise omitted a detail affecting a fraction of the 5% of Americans who buy individual policies – you can keep your insurance if you like it, and it meets the minimum requirements of the Affordable Care Act. Not all policies do. Furthermore, the types of policies being canceled are exclusively ones sold to individuals, not groups. This represents 5% of all health insurance policies sold in the United States, and of those perhaps 65 – 70% of policies cannot exist after January 1st because they don’t meet the bare minimum of what constitutes an insurance policy. 

There’s a reason group policies offer more coverage than individual ones. Volume gives you more for less. Starting January 1st, health insurance policies need to cover pre-existing conditions; if it doesn’t, it’s going to be canceled. Starting January 1st, health insurance policies can’t have a lifetime cap and need to cover lots of things that cut-rate rip-off policies didn’t. 

Now, your policy has to cover preventive care with no co-pay; policies that don’t will be canceled. Now, your policy has to cover maternity care; policies that don’t will be canceled. Now, your policy has to cover mental health care, substance abuse care, lab services, prescription drugs, pediatric oral and vision care, hospitalization, and emergency care; policies that don’t will be canceled. 

That’s the story – that Obamacare finally protects the health insurance consumer from cut-rate insurance, and because of the mandate, all individual policies are treated like group policies. 

Trainwreck? 

The federal exchange website was so bad that only six people signed up the first day. At first glance, that seems horrible. But six people is six more than Republicans wanted to see signed up – that’s infinity percent more. That doesn’t apply in New York, which has its own website, which had its own short-lived problems, but is now working about as well as any high-volume site. Socialization and government takeover of care? That must be why the policies sold in New York under Obamacare come from the same private insurance corporations that sell policies now. 

Jerry Zremski’s article contains salient details about why policies are being canceled, but whoever wrote the headline is deliberately misleading people. Scaring people sells papers

At least 137,000 people in the eight counties of Western New York have received, or will soon receive, a notice that President Obama said they would never get: a notice that their health insurance is being discontinued, and that they’ll have to shop for another plan.

That’s the number of people who get insurance from Buffalo’s three major insurers who are destined to get the government-mandated letter, a jargon-filled tome that one local insurance executive called “a 14-page packet-o-whacket.”

But one line of one version of the letter, which is being sent to people all around the country, is clear.

“Your current plan will cease upon your anniversary date,” said a letter sent to one subscriber in Washington, D.C.

Contrast that line with the words of the president.

“If you like your insurance plan, you will keep it,” Obama said shortly after the Affordable Care Act, his signature health care reform law, was passed in 2010. “No one will be able to take that away from you. It hasn’t happened yet. It won’t happen in the future.”

It’s happening, though, to approximately 12.5 percent of those at BlueCross BlueShield of Western New York, Independent Health and Univera Healthcare, according to numbers the three insurers provided to The Buffalo News.

Under the Affordable Care Act, insurance policies that existed as of March 2010 could be “grandfathered” into Obamacare, so long as they didn’t change significantly in substance and cost; hence, “you can keep your policy if you like it”. But if your policy is being canceled, blame the private insurer. They changed something

And it’s happening for a reason, Obama said in a speech last week in Boston. The law now prevents insurers from offering “substandard” plans, he said.

“One of the things health reform was designed to do was to help not only the uninsured, but also the underinsured,” Obama said.

Zremski’s article goes on to explain the following: 

  • – Healthy NY is changing and adding coverages to comply with the law. People affected will be able to sign up via the NY State of Health program, where people may qualify for generous federal subsidies or even expanded Medicaid coverage. 
  • – Some smaller group policies have to change and add coverages to comply with the law. 

Why, even Chris Collins – who is a multimillionaire Congressman who just a month ago helped to shut the government down in a failed effort to halt Obamacare – complains that his companies can no longer offer cut-rate insurance to its employees. Now, these employees have a right to insurance that includes hospitalization, prescription coverage, emergency services, and mental health coverage. Lashing out at the President, Collins does his best impression of “noblesse oblige”, complaining about how his company is going to manage to offer these new coverages

The cancellation notices are a feature of the Affordable Care Act, not a bug. The idea was to make insurance coverage more robust — and that means cancelling policies that offer less thorough coverage…

…The whole idea of the insurance expansion isn’t to get Americans to purchase anything called “insurance.” It’s to get them to purchase a specific kind of insurance, a plan that is relatively comprehensive and helps protect against financial ruin. If Americans were going to be required to buy a product, the reasoning goes, it should be one that can actually do some good.

Look at the pre-Obamacare individual insurance market this way

The average monthly premiums of the five cheapest plans [in Irvine, California] is $114. So I took the middle plan, HealthNet’s IFP PPO Value 4500. It’s got a $4,500 deductible, a $2,500 deductible for brand-name medications, huge co-pays and a little “bestseller” icon next to it. And it’s only $109 a month — if they’ll sell it to you for that price.

That’s the catch, and it’s a big one. Click to buy the plan and eventually you’ll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn’t rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions.

According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they’ll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can’t. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. So, again, is $109 really the price of this plan?

Obamacare doesn’t take pre-existing conditions or family medical history into account – everyone gets coverage. If your policy was cheap because it only accepted healthy people, it’s going away. 

This 137,000 number is going to be used as a sword against Democrats and the President for a few years. It’s regrettable, because the Obamacare exchanges in New York are going to offer many people better coverage at an affordable rate – oftentimes subsidized. When the scaremongering dies down, people will find that they enjoy having a policy that covers that unexpected hospitalization rather than trying to pay out-of-pocket. People will find that paying for insurance is better than medical bankruptcy, just like having 3rd party bodily injury coverage on your mandated auto plan is better than hiring your own lawyer and selling your house to pay a judgment. 

The story? 137,000 western New Yorkers to get better coverage through a new plan at affordable rates. 

Health Care as a Civil Right

I left this as a comment on Facebook in an ongoing debate over whether Regal Cinemas is going to cut hours to avoid having to offer health insurance to its employees. I am of the mind that Regal and other companies should happily treat their employees like human beings and offer basic benefits such as health insurance. It’s not like ticket prices aren’t already quite high. But to the point, I’d happily pay another buck if I knew that the concession workers and people who cleaned up the theater were properly taken care of. 

Every single western pluralist capitalist democracy has long ago resolved the issue that we don’t allow anyone – rich, poor, or middle-class – to go without access to medical care. Some have mandatory insurance (Switzerland), other have single-payer plans (UK, France, Canada), but all have some system in place to make sure that there is universal health care coverage.  

Except, of course, the United States, which is not only inexplicably proud in some cases of 40+ million uninsured people whose only access to healthcare is an ER, where the federal, state, and local governments already pay billions to reimburse uncollected bills.

How or why in 2013 we can’t get it together to make sure middle class people aren’t stuck with medical bankruptcies, unpaid/unpayable bills, or other lack of access to needed medical care is beyond me. Yet when confronted with this very real fact, the people who purport to be on the side of “liberty” can do little more except glibly to compare, e.g., chemotherapy treatment to a Twinkie, or emergency surgery to owning a TV.

In what we bill as the best and richest country in the world, absolutely you should have a right to food, shelter, and medical care. But if you start telling the middle class that if they get cancer and are uninsured that they can go screw themselves if they can’t afford the treatment, or go into bankruptcy or massive debt, then what sort of system do we have?

Opponents of single-payer point to the Canadian system’s supposed waiting times. Setting aside that, among Canadians, their medical insurance scheme enjoys something close to 90% approval, which is worse, waiting a week or traveling 100 miles for an MRI, or being unable to afford or obtain one at all. 

Medicare for All

nhs_0_108664While our most dysfunctional Congress continues to debate whether we should repeal Obamacare or not, every single other industrialized nation in the contemporary, modern world goes about its merry way having long ago settled the question, “should all our citizens have access to quality health care on demand, regardless of ability to pay?” The American inability or unwillingness to answer that question in the affirmative with some semblance of unanimity is a failure. 

Obamacare is by no means perfect – neither ideal nor, perhaps, even wanted. But it is the great liberal compromise, adopting a conservative way to health insurance reform as its own. Indeed, it seems to be the only way Democrats seem to win lately on national issues – adopt the conservative thinking, and wait for the conservatives to pounce with furious indignation disguised as opposition. 

The very poor and children receive health insurance through Medicaid. The old receive health insurance through the wildly efficient and popular Medicare program. The rest of us, the ones in the middle, are seeing coverage dwindle and cost go up, and we’re told by smugRepublicans that it’s Obamacare’s fault despite it being a year away from full implementation. 

CNN looked at the perpetual American political crisis over healthcare and one conclusion is that we manage disease instead of preventing it. But suggest that people should eat healthier, and you’ll be denigrated as the soda police, as New York Mayor Bloomberg has. 

The issues are cost and access. Medicare is extremely efficient and popular. It is a single-payer health insurance scheme that one pays into throughout their work life and is an “entitlement” insofar as you’ve paid for it, like Social Security. Expansion of Medicare to all Americans is the easiest, most rational way to ensure universal coverage for not only managing disease, but also preventing it. Canadians have liberty, too – liberty from medical bills for routine health care, and the myths that Canadians die while queueing up for services are just that – myths. Canada’s systemis not perfect, either, but it is more perfect than what we have. The British system would be less of a political headache, because it allows for private physician and clinic alternatives – something Canada forbids. 

So, given that every industrialized pluralist democracy in the world offers its citizens some form of universal health care access – as many different models as there are nation-states – why is it that we as Americans move in baby-steps into some sort of conservative plan involving health insurers and mandates? Why not just expand Medicare to all persons of every age, and make health insurance become something truly private and competitive, where you can buy enhanced coverage of some sort on an open market? In other words, if you need cancer treatments that would otherwise cost millions of dollars, you’ll never see a bill. If you want your hospital room to have a spa in it, you can pay extra for that. 

Our revolution was fought to replace a colonial feudalism with bourgeois meritocracy. Expanding health care to all Americans, including the middle class, is something we’ve discussed as a country since the end of World War II. People still, however, go bankrupt from medical bills in what is billed as the greatest superpower in Christendom. It is that – not the notion of “socialized medicine” – which is the disgrace. 

 

The 47% and Irony

Let’s personalize Mitt Romney’s denigration of the 47%. 

Cindy Nerger went to her local Kroger’s to pick up groceries for her family. She paid using her food stamps, but the cashier and then the store manager said that she still owed $10. Ms. Nerger replied that this was not possible, because she knew that food stamps covered everything she had bought. To this, the store manager replied, “Okay, just give it to her.” Nerger said, “see, I told you it was covered by food stamps,” to which the manager replied, “excuse me for working for a living and not relying on food stamps!'”

Granted, it was likely one of the few times the manager of a Kroger’s in the middle of Georgia was able to lord it over anyone else, but still.

When the manager insulted her in that way, Nerger turned and saw the other people in line, felt humiliated, and left the store in tears. 

Moocher. 

But here’s the thing

Nerger said she started receiving food stamps, formally known as the Supplemental Nutrition Assistance Program, when she became eligible for Medicare and Social Security Supplemental Income because of kidney failure in 2008. While she waits for a kidney transplant, she cannot work because of daily 12-hour dialysis treatments. Her husband runs a carpentry business. “If he doesn’t get a call [for a job] we don’t have any extra money for the month,” she said.

Food stamps have been a hot issue in the presidential campaign, with Republicans labeling President Barack Obama the “Food Stamp President” and charging that Obama has deliberately increased dependency on government. The Great Recession and its aftermath have pushed SNAP enrollment to 46.6 million, up from 34 million at the same time in 2009.

Heartbreaking, right? Well, here’s the other thing:

However much the campaign issues might resonate in her personal life, Nerger said she doesn’t have cable and hasn’t been following politics or the presidential election. Still, she doesn’t think much of either Obama or his Republican opponent, Mitt Romney.

“They’re all gonna kill us,” she said. “Most of the people that we have to choose from — Obama with his spending and his health care reform, and then Mitt Romney, he just wants to let poor people die, so either way we’re doomed. So I don’t see any point in voting.”

Scroll back up to the part where she’s a Medicare recipient. She is a beneficiary of a federally run single-payer health insurance program and denigrates Obamacare and “spending”.

WTF, people. 

$1.6 Million Missing From Possible Cancer Cure

This article from the Telegraph is somewhat heartbreaking. Sitting in a freezer in the middle of Sweden is a virus that has been proven to target and kill cancer cells – and cancer cells only. The only side-effects are mild flu-like symptoms

It is a fact of human biology that healthy cells are programmed to die when they become infected by a virus, because this prevents the virus spreading to other parts of the body. But a cancerous cell is immortal; through its mutations it has somehow managed to turn off the bits of its genetic programme that enforce cell suicide. This means that, if a suitable virus infects a cancer cell, it could continue to replicate inside it uncontrollably, and causes the cell to ‘lyse’ – or, in non-technical language, tear apart. The progeny viruses then spread to cancer cells nearby and repeat the process. A virus becomes, in effect, a cancer of cancer. In Prof Essand’s laboratory studies his virus surges through the bloodstreams of test animals, rupturing cancerous cells with Viking rapacity.

Unfortunately, the man behind this discovery needs – and doesn’t have – about $1.6 million to handle the health and safety regulatory paperwork needed to start human clinical trials. 

Swedishly uninterested in profiteering, devoted only to the purity of science, Magnus and his co-workers on this virus have already published the details of their experiments in leading journals around the world, which means that the modified virus as it stands can no longer be patented. And without a patent to make the virus commercial, no one will invest. Even if I could raise the £2 million (I want only the best version) to get the therapy to the end of phase II trials, no organisation is going to step forward to run the phase III trial that is necessary to make the therapy public.

‘Is that because pharmaceuticals companies are run by ruthless plutocrats who tuck into roast baby with cranberry sauce for lunch and laugh at the sick?’ I ask sneerily.

‘It is because,’ Kjell corrects me, ‘only if there’s a big profit can such companies ensure that everyone involved earns enough to pay their mortgage.’

If you donate $1.6 million, you can have the potentially historic cancer-killing virus named after you. If you want to donate against that sum, donations are being accepted at The Oncolytic Virus Fund, Box 256, SE-751 05 Uppsala, Sweden. 

Finally, given the tenor and content of the health insurance debate in this country, this should not go unnoticed: 

…Uppsala University Hospital, a European Centre of Excellence in Neuroendocrine Tumours. Patients fly in from all over the world to be seen here, especially from America, where treatment for certain types of cancer lags five years behind Europe.

Sweden has a redistributive socialist universal health care system – among the best in the world.  It is a point of pride for the country that equal access to health care ensures a healthy population. The United States can’t even agree on that goal yet, much less the means with which to attain it. 

Obamacare: The Mandate And the Taxing Power

Oftentimes, the federal government finds itself wanting to promote a certain behavior as part of a national program, but without the direct power to do so. By way of example, in the 1980s, the Reagan Administration decided that it wanted the drinking age to be raised from 18 to 21 nationwide. But the drinking age isn’t a federal, but a state statute. In order to persuade states to raise the drinking age, the federal government passed an incentive plan. If a state failed to raise its drinking age to 21, it would find itself with a diminution in federal highway funding. 

“The power to tax involves the power to destroy”, wrote Chief Justice John Marshall in 1819. With respect to the Affordable Care Act, or “Obamacare”, the power to tax also involves the power to build something. Under the law, beginning in 2014, Congress will require most Americans to obtain health insurance, or – if you don’t, you pay a fine to the government. The mandate was, ironically, a precondition set by the insurance industry, without which they would not be able to economically justify offering insurance to people with pre-existing conditions at no penalty.

The key part of Chief Justice Roberts’ opinion yesterday reviewed the constitutional justification for that mandate to purchase health insurance.  Congress’ powers are specifically limited and enumerated in Article 1 of the Constitution. 

Roberts turned first to the Commerce Clause (Article 1, Section 8), whereby Congress has the power to “regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”  Roberts rejected the argument that the government could regulate the absence of commerce; you cannot regulate that which does not exist.  His analysis seems somewhat limited, however. After all, there is not a personal alive who isn’t engaged in the health care market now, or inevitably. Even if you’re not seeking medical care, you’re paying for others’. 

Right now, you and I (and everybody) are taxed to help pay for uninsured people’s emergency room visits. ERs can’t turn people away, and oftentimes the poor and uninsured use them for primary care.  Those hospitals seek reimbursement for the cost of providing those services through two Federal Programs, Disproportionate Share Hospital (DSH) and Upper Payment Limit (UPL)–that require a 50% local share match. So…instead of forcing the cost of health care provision onto the people who don’t have insurance, you (a taxpayer, or a person with insurance) are paying for them to get health care with both your federal and county tax dollars. 

Secondly, Roberts turned briefly to the “Necessary and Proper” Clause, also in Article 1, Section 8, it reads, “The Congress shall have Power – To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.”  Roberts declined to go along with this, reasoning that…

Each of our prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power. For example, we have upheld provisions permitting continued confinement of those already in federal custody when they could not be safely released…[t]he individual mandate, by contrast, vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power.

And so, the last resort – the “in the alternative” argument – was most persuasive to the 5 members of the Court who voted to maintain the ACA mandate. The very first Congressional power enumerated at Article 1, section 8 involves the power to tax and spend. Roberts wrote that Congress’ mandate isn’t the issue – it’s the “penalty” imposed on people who refuse to purchase insurance. While the dissent argued that the government is semantically blocked from calling the “penalty” a “tax”, Roberts argued that the word “penalty” assumes some sort of fine for illegality. Yet the refusal to purchase insurance isn’t illegal – it isn’t a crime. It is merely a choice, and a person’s choice to opt to pay a tax instead of buying insurance is one that government can regulate under its taxing power. 

…the Government asks us to read the mandate not as ordering individuals to buy insurance, but rather as imposing a tax on those who do not buy that product…

…None of this is to say that the payment is not intended to affect individual conduct. Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry

Because Roberts invoked the taxing power, dumber pundits and lazy politicians have pivoted to calling it all – the whole law – a “huge tax”.  Perhaps they should read the law, and then read the Court’s opinion. It’s not a “huge tax”. It’s a mandate that you have health insurance. Chances are, you already have it – it’s not like you’re being forced to buy super-more health insurance on top of what you may already have. And if you don’t have it, you’ll have much easier and cheaper access to health insurance. And if you choose not to have any at all, then you’ll be assessed a fine, a tax, whatever you want to call it. 

The ACA’s “shared responsibility payment”  is a tax only on people who choose not to hold insurance. Anyone who says otherwise is ignorant, mistaken, and/or lying. 

With the mandate in place, no longer will the person without health care get away with not paying hospital bills, and no longer will taxpayers be “mandated” to subsidize those choices. Instead, the person making the choice to avoid insuring himself will be assessed a tax in the eventuality that he becomes ill and can’t afford to pay his bill. Do you want the person without health care to be taxed, or do you want to continue to be taxed because they don’t have health care?

In the olden days, “personal responsibility” was a conservative talking point.  Now, we’re essentially codifying it through Obamacare – you’re responsible to get coverage, or for the consequences if you don’t. Now? 

The remaining portions of the decision dealt with (a) the Court’s analysis of whether the issue was ripe for decision (it is); (b) whether striking the mandate meant invalidating the whole law (they didn’t have to reach it); and (c) a provision dealing with the expansion of Medicaid, holding that States can reject federal funding and therefore not comply with the new rules. 

The misinformation and disinformation being spread over the last 24 hours has been simply mind-blowing. For instance, here’s a fundraising email that Republican congressional candidate Chris Collins (who, incidentally, never, ever has to worry about not being able to afford anything, ever, including health care) sent yesterday: 

Dear friend,

The Supreme Court has confirmed what we already knew – ObamaCare is nothing more than a massive tax increase that will hurt hardworking families and continue to act as a wet blanket on economic growth and job creation.

Today, I’m asking for your donation of $27 dollars to protect the residents of the 27th Congressional District from this massive tax hike and help end ObamaCare.

I need your help to stop Kathy Hochul and Barack Obama from raising taxes on thousands of Western New York and Finger Lakes families. 

$27. 

$27 is how we can protect our families in the 27th Congressional District from massive tax increases.

When I go to Congress, my first order of business will be to lead the fight to repeal ObamaCare and replace it with common sense solutions that protect seniors and don’t crush small businesses and cost us jobs.

$27 can get us there.

Whether it’s $27, or $5, $10, $50 or $100 – anything you can do to help us stop Barack Obama and Kathy Hochul from raising taxes and cutting Medicare by $500 billion is so important.  Will you consider donating today?

There’s so much at stake, and I need your help.

Sincerely,

CHRIS COLLINS

Congressional Candidate, NY-27

No, it’s not one side or another that won or lost – everybody won. Everybody will benefit from the implementation of Obamacare. It isn’t at all a huge tax increase, and the only reason Medicare funding goes down is because the ACA picks up the slack. Obamacare isn’t a “huge tax increase”, indeed it will help families by reducing the most common type of bankruptcy – ones brought about through medical expenses. Is this law a boon to insurers? Yes. That’s why many progressives didn’t like it much, and that’s why the law is something of a Frankenstein’s monster. But Obamacare, like its progenitor, Romneycare, is a fundamentally conservative idea. Because it’s been adopted by a Democratic President whom the Republicans are determined to ruin, it is now characterized as something it’s not. 

And make no mistake – the Republican drive to ruin Obama is so concentrated and driven, that it doesn’t matter what collateral damage there is to average Americans, or the economy. 

It’s not surprising to see a politician lie, but when mere puffery, (“I’m the best”), turns into brazen lying, (“I poop rainbows and spit unicorns”), you have to wonder what the politician thinks of the people who are going to vote for him. I heard some of our right-wing omniphobe media personalities liken the United States under the ACA to North Korea. There was heavy emphasis on “Hussein” yesterday, because “Hussein” is a foreign, Muslim name, and because somehow that correlates with socialism. Or something. I wish I was a professional psychologist so I could better analyze what was taking place.  Even Mitt Romney noted that the Court didn’t hold that Obamacare was a “good policy”. That’s jaw-droppingly dumb – Palin dumb. 

Requiring Americans to buy private health insurance from private corporations is socialist? Spreading the risk across most Americans so that health insurers can’t refuse to insure people with pre-existing conditions is like living in a Stalinist dictatorship with no market, no freedom, no food, no money, closed borders, and extensive gulags? How dumb. Almost as dumb as the many people who took to Twitter to decry the loss of America’s freedom and announce that they’d move to Canada, which has true single-payer socialized medicine. 

Set aside the crazies and the liars – Americans won today. The ACA – Obamacare – isn’t a perfect solution. No solution is perfect, after all. But it will make our health insurance in this country more affordable, with better coverage, and no longer will you live at the mercy of health insurance companies, fearing arbitrary rate hikes, lifetime payout maximums, or being barred from buying insurance due to a pre-existing condition if you change your job. This is good for people

ObamaThread: MANDATE UPHELD UPDATE

If you haven’t already read about how Bain Capital’s buy ’em, gut ’em, and outsource ’em M.O. destroyed a healthy, longstanding WNY business, and you haven’t already been informed about how Mitt Romney made his millions by doing that repeatedly, over and over again, then you should go and do that. 

In the meantime, the big news today will be what the politicized, partisan, conservative-activist Supreme Court will do with the Obamacare mandate to buy health insurance. Will it be ruled unconstitutional? If so, will it render the whole law a nullity, or will it be severed from the remainder of the law? If severed, will the law be able to be maintained? 

The fundamental brokenness of our idiotic, inefficient, Balkanized way of paying for health care that isn’t even the best in the world is one of the big failures of the post-WW2 era. As postwar Europe built its social safety nets, the US couldn’t get out of its own way to do the same. The 1964 law creating Medicare and Medicaid was originally supposed to provide all Americans with universal health care. It never happened. Soshulizm. 

So, instead, we operate under a largely for-profit form of privatized socialism. (Yes, insurance is socialism – it’s the redistribution to claimants of wealth earned from premiums). 

The United States, as we all know, is the last remaining western pluralist democratic capitalist country that does not guarantee free health care to all of its citizens. Obamacare taught us a lot. It taught us that a mixed-race Democratic President can propose a fundamentally conservative health care reform bill, manipulate changes to it to try and obtain buy-in from people who had very recently proposed it, and still the Republicans would vote against it uniformly because it would do political harm to said President.

It highlighted that politics trumps policy; that obstruction trumps governing.

Maybe – just maybe – the failure of the Frankencompromise of Obamacare will lead to a massive push to abolish Medicaid and expand Medicare to all Americans. 

Medicare for all Americans. A program that is uniquely popular, has very low overhead, and would be voluntary. People like Mitt Romney and Chris Collins could continue to buy health insurance from private companies and be Lear-Jetted to gold-encrusted, faraway clinics, if they wish. But taking away the average American’s expenses for health care would do wonders for the economy. Taking away businesses’ responsibility to provide elaborately complicated and ridiculously expensive private health care options would also be able to increase efficiency, productivity, and profitability. 

It would be a single-payer system for those who want it. For those who don’t, buy something different – not dissimilar from the English model, rather than the far less flexible Canadian model. You know, Canada, which has a really good economy, little corruption, no bank collapse, and more or less the same freedoms we enjoy. 

This is a SCOTUS Obamacare ruling open thread. Enjoy your Thursday. 

UPDATE: The individual mandate, and Obamacare, is upheld as a constitutional use of congressional taxing power with respect to the penalty for not buying health insurance. 

Hochul

“Today’s Supreme Court ruling provides much needed clarity in an important national debate on the appropriate role of the federal government in the delivery of healthcare. While I was not in Congress to vote on the Affordable Care Act, I have always believed, and continue to believe, that the law is far from perfect, and I remain concerned about the high cost of implementing the law.  That is why I have worked to roll back many of its most troubling provisions, including the financially unsustainable CLASS Act, the Medical Device tax, and the Independent Payment Advisory Board, which could result in the rationing of Medicare.

 “I am hopeful that today’s ruling will help to focus our country on the need for more effective policies that drive down the cost of care and ensure that all Americans—especially children, seniors and veterans—have access to quality and affordable health care.  I stand ready to work with my colleagues on both sides of the aisle to continue to improve the law and find appropriate solutions to the rising cost of health care in this country.”

Higgins

“Today the Supreme Court, in an opinion authored by Chief Justice John Roberts, held that the Affordable Care Act is constitutional. Under the law, this year over 3 million New Yorkers have begun receiving free preventative care, over 3,000 New Yorkers with pre-existing conditions are no longer denied health insurance coverage, 160,000 young adults in New York State are now receive health coverage through their parents’ plan, and 254,083 New York State seniors on Medicare are saving an average of $655 on their prescription medications.

“The old way of doing business was unaffordable, unacceptable and unsustainable for taxpayers and patients alike. Despite exorbitant expense, according to the World Health Organization, the United States is 37th of 192 countries in terms of overall healthcare quality.

“The Western New York health community is already leading the way on health reform. They have embraced electronic medical records and the formation of comprehensive care organizations. This law gives Western New York the tools we need to go farther and it gives the rest of the country the opportunity to follow our lead.

“Much of the Affordable Care Act was modeled on the Cleveland Clinic standard, care Western New Yorkers frequently travel to receive.  Cleveland Clinic quality care is the health care I want for my family, my community and my nation.”

Slaughter:

Congresswoman Louise Slaughter (NY-28) today applauded the Supreme Court’s decision which upheld the life-saving provisions of the Affordable Care Act. Slaughter, one of the leading supporters of the ACA, has been in the forefront of the effort to improve access and quality of health care for American families.

 “I am very pleased that the Supreme Court has upheld the landmark Affordable Care Act,” said Slaughter. “I was proud to bring this bill to the floor of the House of Representatives as Chairwoman of the Rules Committee in 2009, and I continue to be proud of the ways in which the law has improved health care access for millions of Americans. We worked long and hard to protect Medicare’s guarantee of quality health care for our seniors and to make health care more affordable for American families. The ACA also ensures that being a woman is no longer a pre-existing condition and a justification for higher premiums.

 “This groundbreaking legislation was never about politics – it was about saving lives and safeguarding the health and wellbeing of American families. I know that much work remains to be done but I am gratified to know that we are a step closer to ensuring that no American will live in fear of losing their home and everything they own because they or a member of their family is stricken by illness.”

 Because of the provisions of the Affordable Care Act, Americans are already seeing lower costs and better coverage: 

  •          54 million Americans in private plans have received one or more free preventive services.
  •          In addition, in 2011, 32.5 million seniors received one or more free preventive services.  So far in 2012, 14 million seniors have already received these services.
  •         105 million Americans no longer have a lifetime limit on their coverage.
  •         Up to 17 million children with pre-existing conditions can no longer be denied coverage by insurers.
  •         6.6 million young adults up to age 26 have taken advantage of the law to obtain health insurance through their parents’ plan, of whom 3.1 million would be uninsured without this coverage.

     

  •         5.1 million seniors in the ‘donut hole’ have saved $3.2 billion on their prescription drugs, an average of $635 per senior.

     

  •         In 2011, 2.3 million seniors had a free Annual Wellness Visit under Medicare.  So far in 2012, 1.1 million seniors have already had this free visit.
  •          In 2011, 360,000 small employers used the Small Business Health Care Tax Credit to help them afford health insurance for 2 million workers.

 Slaughter is a champion of the life-saving changes that have been implemented as a result of the Patient Protection and Affordable Care Act.  Thanks to these lifesaving provisions, children can stay on their parents’ insurance until the age of 26, insurance companies can no longer deny a person health insurance, and millions of seniors now have free access to life saving health care- all while reducing the federal deficit by billions of dollars.

 Thanks to the Affordable Care Act, in New York’s 28th district:

·         5,500 young adults in the district now have health insurance. 

·         10,400 seniors in the district received prescription drug discounts worth $6.7 million, an average discount of $640 per senior. 

·         70,000 seniors in the district received Medicare preventive services without paying any co-pays, coinsurance, or deductibles. 

·         22,000 children and 100,000 adults now have health insurance that covers preventive services without paying any co-pays, coinsurance, or deductibles. 

·         430 small businesses in the district received tax credits to help maintain or expand health care coverage for their employees. 

·         $10.9 million in public health grants have been given to community health centers, hospitals, doctors, and other healthcare providers in the district to improve the community’s health. 

·         7,000 to 32,000 children with preexisting health conditions can no longer be denied coverage by health insurers.

CNN, the Buffalo News, Channel 2 all reported incorrectly that the mandate had been stricken.

 

 

WBEN texted people that the mandate had been stricken and didn’t fix the error for over an hour.

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