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SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1, 183, 386, 590]

Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1]

Are you denying that Republicans were still touting an individual mandate as a potential source of compromise as late as summer 2009? Are you gonna make me find the quotes to prove you wrong?

Once the Tea Party came into existence that all became as meaningless as the career of Senator Richard Lugar.



Nope. They (along with every other Republican who had previously advocated a health care system which looked a lot like PPACA) decided to put raw partisanship ahead of their country, and did an about-face.

Both sides are totally partisan. In fact the Senate hasn't been this partisan since the administration of James Buchanan. What should be doesn't matter. What does matter is reality.



Agreed.



A few possibilities:
1. Perhaps another election will drive out all of the crazies who have taken over the GOP in the last three years, and the party will go back to the sane (if inadequate) health care positions they held in the late 2000s. And therefore compromise will be possible.
2. Perhaps some of those problems will be fixable in exactly the way Republicans want to fix them anyway, and so they'll eagerly vote to fix them.
3. Perhaps the Democrats will indeed get a commanding majority in the Senate, the House, and the White House.
4. Perhaps the filibuster will be eliminated and they'll only need 50 votes in the Senate.

1. A new heaven and earth must be born before that is possible. You have no idea how deeply conservatives are aroused.

2. Neither side believes in the good faith of the other side. When you don't believe that the other party to a negotiation has acted in good faith you set them up. You don't work with them.

3. Only if George Bush becomes president again.

4. Silencing half the population is a recipe for disaster. History warns against such an approach.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

I pay CASH now for my medical care and see a doctor every three months, am on blood thinners for life and see no reason to buy insurance to cover NORMAL medical care, at 58 I am in "average" shape dispite having had major past medical problems. I get discounts of well over 60% because I pay cash at the time of my medical treatment, they don't even have to mail a bill to me. I buy my medications 90 days at a time, saving 66% (over the 30 day supply amount) AND get a cash discount for that as well.

Much of our medical care cost inflation is BECAUSE of insurance and its associated massive paperwork overhead and payment delay. The preventive care is only as good as the patient is at following the doctors advice. If you are overweight and out of shape that is a PERSONAL problem that likely becomes a "medical" problem, there is no magic "get in shape" pill. Much of true preventive "care" is simply having a decent diet and execise routine.

I have most of my "health" problems due to the accumulated damage from multiple motorcycle accidents and the related plates/screws, bone grafts and soft tissue damage from them. I "lived hard" and now must pay the price for it. I want only a "catastrophic" medical insurance policy that has a $5,000 annual deductable and pays 100% of medical costs beyond that, so ObamaCare for me is the problem and not the solution.

Well, nonetheless, the more preventative care and the more accessible it is, and the cheaper, the less costly medical care ends up being overall. So while the scenarios you describe happen I'm sure, on balance, it seems to still be a very good idea. Countries with better preventative care consistently trounce us both on quality and costs.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1]

1. A new heaven and earth must be born before that is possible. You have no idea how deeply conservatives are aroused.

I'm not necessarily saying THIS election. Maybe the next one, or the one after that.

2. Neither side believes in the good faith of the other side. When you don't believe that the other party to a negotiation has acted in good faith you set them up. You don't work with them.

The Democrats believed in the good faith of Republicans until the ACA. That's why they tried so hard for months during the summer of 2009 to get a compromise, until they realized that the Republicans were just ****ing with them and had no intention of giving any ground on anything.

3. Only if George Bush becomes president again.

A Bush-like figure is hardly out of the question. If the next Republican president overreaches it could happen again. Not that it's particularly LIKELY, just that it's a possibility.

4. Silencing half the population is a recipe for disaster. History warns against such an approach.

History? What are you talking about? The filibuster has only been abused for the last 20 years or so, and it has only been required for virtually every single piece of legislation for the last 3 years or so. And in any case, I'm not going to debate the wisdom of removing the filibuster here...it's just one possible way in which necessary modifications to the PPACA could be implemented.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

In the last two courts, about 20% of rulings have been 5-4.

Ive been searching for 20 minutes and I cant find any information on what percentage of votes have been made by swing...Im not saying your incorrect...Im saying I cant find it.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Well, nonetheless, the more preventative care and the more accessible it is, and the cheaper, the less costly medical care ends up being overall. So while the scenarios you describe happen I'm sure, on balance, it seems to still be a very good idea. Countries with better preventative care consistently trounce us both on quality and costs.

Perhaps they just have fewer morons, both in their general population and in their gov'ts. Many nations have much better schools too, and spend far less on education. Many nations have been safe from foreign attack, don't play world policeman, and get by with far less military spending. Much of what our gov't does, and our population meekly allows, does not make much sense, yet we plod along building massive debt and hoping for change. Any nation that taxes wages, to support out-of-wedlock child birth, is not thinking very clearly. USA, USA, USA...
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Perhaps they just have fewer morons, both in their general population and in their gov'ts. Many nations have much better schools too, and spend far less on education. Many nations have been safe from foreign attack, don't play world policeman, and get by with far less military spending. Much of what our gov't does, and our population meekly allows, does not make much sense, yet we plod along building massive debt and hoping for change. Any nation that taxes wages, to support out-of-wedlock child birth, is not thinking very clearly. USA, USA, USA...

Why would morons be more frequently distributed here than anywhere else in the world? Be careful here...
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Well, nonetheless, the more preventative care and the more accessible it is, and the cheaper, the less costly medical care ends up being overall.

This isn't a complete sentence, but if I'm interpreting you correctly, you think that opening wide the public's access to preventive care makes medical care cheaper overall. Yes?

This is false.

Our outpatient/clinic care is more than twice as expensive as Sweden's, which has the second-most expensive in the world. Letting the entire population rack up whatever amount of this they need to "prevent" illness is not a cost-saver.

Preventive care is cost-saving only with respect to a certain few conditions which are relatively cheap to screen AND much cheaper to fix if caught early. But because they're so cheap, people should largely be able to pay for them out of pocket. Example, a colonoscopy every so often past the age of 50 should not be a bank-breaker, and is an effective preventive measure because they can snip out those pesky polyps.

Recap: the reason that preventive care is not cost-effective here is because outpatient care is already astronomically more expensive here than anywhere else on Earth, so opening the floodgates of access just means we're spending oodles more per capita on our country's health care.

Countries with better preventative care consistently trounce us both on quality and costs.

That doesn't mean preventive care is the cause of either.
 
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Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Why would morons be more frequently distributed here than anywhere else in the world? Be careful here...

As your cost, per student, of education increases, yet your nation continues to drop, in global education ranking, it begets more morons. These morons have been given very high self esteem, just look at their high grades, and don't even know that they are morons; so be careful here. As these morons vote they elect morons, as these morons govern they spend much more and accomplish much less.

Look at what we NOW spend on medicare, per person annually (by state), and how we want to add many more to that program, as part of ObamaCare: What is the cost per person annually for medicaid

Only a moron could call that wise use of tax money. ;-)
 
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Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

This isn't a complete sentence, but if I'm interpreting you correctly, you think that opening wide the public's access to preventive care makes medical care cheaper overall. Yes?

This is false.

That doesn't mean preventive care is the cause of either.

Well, the World Health Organization, and really pretty much every organization that has studied the question certainly says that is the main factor. What studies is your point of view based on?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

It now appears that the dissent of the conservative Justices was at one time the majority opinion, and that Roberts changed his vote based on intimidation. He was intimidated by threats to delegitimize the Supreme Court if Obamacare wasn't validated. It may be that Chief Justice put his fears about the institution of the Supreme Court over his duty to interpret the Constitution. If this is true, Chief Justice Roberts breached his duty to the Constitution.

We certainly have some....um, interesting takes ..... on various items on this board. I, for one, appreciate the active imaginations of some.....
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

because this law will help the greater-good of our society, I support it.

and I even though I have issues with the legal arguments of the SCOTUS, I still support their decision, especially from a moral perspective.

As I've said before...the road to hell is paved with good intentions.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

You mean they disagree with Socialized HC that liberals try to label as "Health Care Reform"

Socialized Medicine is not Health Care Reform.

This bill is not socialized medicine, you don't know what that word means.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Tort reform - A minor issue. In any case, this *was* offered as a bargaining chip to get Republicans on board. Obama said many times that he was willing to play ball on tort reform. No dice.

Youre kidding. No I mean really, you have to be joking with that stance.

The costs of defensive medicine
In recent studies, more than 90 percent of physicians reported practicing positive defensive medicine in the past 12 months; unnecessary imaging tests accounted for 43 percent of these actions. More than 92 percent of surgeons reported ordering unnecessary tests to protect themselves.

Another study found a direct relationship between higher malpractice awards and malpractice premiums and Medicare spending, especially with imaging services. The increased spending, however, had no measurable effects on mortality.

In a recent Gallup survey, physicians attributed 34 percent of overall healthcare costs to defensive medicine and 21 percent of their practice to be defensive in nature. Specifically, they estimated that 35 percent of diagnostic tests, 29 percent of lab tests, 19 percent of hospitalizations, 14 percent of prescriptions, and 8 percent of surgeries were performed to avoid lawsuits.

Liability reform has been estimated to result in anywhere from a 5 percent to a 34 percent reduction in medical expenditures by reducing defensive medicine practices, with estimates of savings from $54 billion to $650 billion.

http://news.vanderbilt.edu/2012/02/defensive-orthopaedic-medicine/
Vanderbilt University Medical Center researchers estimate that U.S. orthopaedic surgeons create approximately $2 billion per year in unnecessary health care costs associated with orthopaedic care due to the practice of defensive medicine.

Defensive medicine adds billions to healthcare costs | Healthcare Finance News
ATLANTA -- Physicians estimate the cost of defensive medicine to be between 26 and 34 percent of total annual healthcare costs, according to a recent report by Jackson Healthcare. At an estimated $2.5 trillion in annual spending, this means $650-850 billion is spent each year on medical orders intended to avoid lawsuits rather than treat patients.

UConn Advance - February 23, 2009 - Study shows defensive medicine widespread
The cost of ‘defensive’ medicine – tests, procedures, referrals, hospitalizations, or prescriptions ordered by physicians fearful of lawsuits – is huge and widespread, according to a study by the Massachusetts Medical Society and UConn Health Center researcher Robert Aseltine Jr.

The study is based on a survey – believed to be the first of its kind – that was completed by more than 900 physicians in Massachusetts. It asked about their use of seven tests and procedures: plain film X-rays, CT scans, magnetic resonance imaging, ultrasounds, laboratory testing, specialty referrals and consultations, and hospital admissions.

About 83 percent reported practicing defensive medicine, with an average of between 18 percent and 28 percent of tests, procedures, referrals, and consultations and 13 percent of hospitalizations ordered for defensive reasons.

Such practices were estimated to cost a minimum of $1.4 billion per year in Massachusetts.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1]

Are you denying that Republicans were still touting an individual mandate as a potential source of compromise as late as summer 2009? Are you gonna make me find the quotes to prove you wrong?

Nope. They (along with every other Republican who had previously advocated a health care system which looked a lot like PPACA) decided to put raw partisanship ahead of their country, and did an about-face.

Let me help:

See Mitt Romney Promote an Individual Mandate - YouTube





Agreed.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

It now appears that the dissent of the conservative Justices was at one time the majority opinion, and that Roberts changed his vote based on intimidation. He was intimidated by threats to delegitimize the Supreme Court if Obamacare wasn't validated. It may be that Chief Justice put his fears about the institution of the Supreme Court over his duty to interpret the Constitution. If this is true, Chief Justice Roberts breached his duty to the Constitution.

Just so we all understand you..... I am hearing that you are upset about a Republican appointed SCOTUS justice being key in striking down a Republican challenge to a Republican idea (the Mandate was invented by the Heritage Foundation) that was implemented in Massachusetts by the current Republican nominee for POTUS?

Sounds like the Gang that Couldn't Shoot Straight to me.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

Not sure what you mean. How does anything in the ACA reduce the quality of care for anybody?

What do you think will happen when thirty million more people are suddenly added to Medicaid?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1]

How was it illegitimately used? It was used for precisely its intended purpose; two provisions of the reconciliation bill were even removed because they failed to meet the standards necessary for reconciliation.



An academic point, since the main content was in PPACA which passed under the normal process. The only things that passed via budget reconciliation were relatively minor tweaks to the bill.

What did President Obama say would be the budget impact of Obamacare during the first ten years?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

The Supreme Court just affirmed that you are free to go without health insurance if you like; that's completely fine. You just have to pay an irresponsibility tax, to cover the costs for when you end up in the emergency room and stick the public with the bill.

What limit is there on the federal power of taxation after Chief Justice Roberts' opinion in Roberts v. America?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

I don't know all the details, but probably not. It's sort of a subspecies of the freeloader problem. People get those kinds of plans and then skimp on preventative care and it ends up creating most costs in the long run.

How do HDHPs create high costs in the long run? If you're too cheap to pay for yearly check-ups out of pocket with such a plan, the only person you cost is yourself with your high deductible costs.

The WHOLE POINT of HDHPs is that you place responsibility of cost and risk onto yourself. If you want to argue about people "freeloading," then argue about the people who only pay 10 dollars to see the doctor and waste resources every time they have a cough.
 
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Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

What do you think will happen when thirty million more people are suddenly added to Medicaid?

I think that 30 million more Americans will get much needed care. Am I supposed to feel bad that you might have to wait an extra week to have your ass boil lanced so that 30 million Americans can have preventive care?
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

There is no way to know if this is true and I seriously doubt it is. I think it's more likely that he believed that overturning Obamacare would have been a form of judicial activism.

It doesn't matter whether this is true or not. This will be used according to the terms of American political culture. A Kingdom of Lies has little use for the complete truth. Remember, both sides play this game the same way. The point is to delegitimize the other side initially in the eyes of your own side. That's what happened to President Bush after Bush v. Gore.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

I think that 30 million more Americans will get much needed care. Am I supposed to feel bad that you might have to wait an extra week to have your ass boil lanced so that 30 million Americans can have preventive care?

Providing care to the 30 million more Americans who have nothing to offer to the pool means not only that per capita health care expenditures increase, but that the burden of covering them weighs down that much more heavily on... whoever has any money left.

You are supposed to feel bad about that, yes. The goal here needs to be about suppressing the costs of medical care, not flinging ever more costs onto the taxpayer.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2[W:1]

First of all, "the administration" doesn't give the CBO any numbers to score.

The assumptions are contained in the legislation that is presented to the CBO.

The CBO looks at the legislation on its own and assesses the ten-year cost of the bill. Want to know why the ten-year cost is higher now than it was when the bill was first past? Because it's two years closer to actually being implemented. This was hardly an unforeseen cost of the bill; that's been part of the cost all along.

Obamacare will go on forever. It won't end in ten years or twelve years. The cost overrun will go on year after year after year. Actually the way to sabotage Obamacare is to cause the budget deficit to explode along with the national debt while the political system remains paralyzed. What entitlement program ever comes in at or under budget. Costs always explode in unforeseeable ways. Democrats will have to have conservative cooperation. But conservatives don't believe Democrats act in good faith. That's a problem for the left isn't it?

In fact, the financial figures are actually slightly BETTER (although within the margin of error) for the ACA than they were at the time it was passed.

With all due respect, and admiration for your tenacity, you are honestly mistaken. You base your opinion on the dissembling of others.



The CBO confirmed a few months ago that the ACA is still on track to reduce the deficit. And the most recent estimates I've seen indicate that they initially slightly underestimated the deficit reduction.

Are you saying that the CBO didn't report earlier this year that Obamacare will cost $1.76 trillion? Can you name an entitlement program that has ever come in under budget or at budget over a period of twenty years? There are a lot of sick old folks who are going to overwhelm America during the next twenty years. The way to break Obamacare is to have it harm the economy and screw up people's lives. Those are the rules of the game.



As I already mentioned, only a minor part of the act was passed via budget reconciliation. So even if your misinformation about the ACA increasing the deficit were true, all that Congress would need to do was make sure that those minor provisions passed via reconciliation didn't increase the cost of the deficit, rather than the entire bill.

Do you think conservatives are going to believe you or me. It's only necessary to persuade conservatives in order to monkey wrench Obamacare over the years.



60 senators did indeed vote for the PPACA, which was signed into law as-is.

The meme on the right is that the Democratic Senate victories in Minnesota and Alaska that gave them sixty votes for a brief period of a few months was occasioned by voter fraud in the former case and prosecutorial malfeasance in the latter case. Remember, it's only necessary to persuade conservatives in order to monkey wrench Obamacare's implementation.



Because that's the agreement that the Senate Democrats made with House Democrats: The House would vote to pass the Senate bill (PPACA) as-is, but in exchange the Senate had to pass the House's minor tweaks via budget reconciliation.

You and I will have to agree to disagree.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

How do HDHPs create high costs in the long run? If you're too cheap to pay for yearly check-ups out of pocket with such a plan, the only person you cost is yourself with your high deductible costs.

The WHOLE POINT of HDHPs is that you place responsibility of cost and risk onto yourself. If you want to argue about people "freeloading," then argue about the people who only pay 10 dollars to see the doctor and waste resources every time they have a cough.

NO, the costs don't just land on the freeloader, they hit everybody. Maybe later they sign up for full fledged insurance, maybe the vast majority of their costs are over the deductible anyways. Either way, the costs end up driving up the cost of insurance. Preventative care is way cheaper than treating preventable conditions. Like a tiny fraction of the cost.
 
Re: SCOTUS LIVEBLOG - Obamacare Mandate Survives-Part 2

I think that 30 million more Americans will get much needed care. Am I supposed to feel bad that you might have to wait an extra week to have your ass boil lanced so that 30 million Americans can have preventive care?

Adam, you are supposed to feel bad because you can foresee the future just like Cassandra. You and I both have a reasonable idea about what will happen without conservative acquiesence to the decision in Roberts v. America. That's why you can't enjoy this victory. You know in your heart that this isn't over.
 
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