AI
Saturday, March 31, 2012 6:32:56 AM
Insurance Mandate A Tough Sell To Justices
by Scott Hensley .. 12:27 pm .. March 27, 2012
John Rose/NPR
Supporters and opponents of the health care law rallied in front of the Supreme Court
Tuesday, as the court considered the constitutionality of the insurance mandate.
Today's arguments hit the core of the Affordable Care Act: the mandate that
requires just about everyone to have health insurance starting in 2014.
Special Coverage .. [two of] .. Supreme Court Arguments
http://www.npr.org/series/148920753/judging-the-health-care-law
Nina Totenberg: Mandate's Fate Seems To Rest On Kennedy, Roberts
http://www.npr.org/2012/03/27/149480728/supreme-court-justices-weight-mandate
And the U.S. Supreme Court's justices appeared split on whether the federal government can force people to buy health insurance. The court's conservatives appeared skeptical and unmoved by the government's arguments in favor of the mandate.
"The government had a hard time, and if they win, they win narrowly," NPR's Nina Totenberg reported from outside the court. "I don't think you can call this."
The law says that if you're not covered by Medicare, Medicaid or insurance provided by your employer, then you'll have to pony up for coverage on your own or pay a fine.
Those challenging the law say the federal government is going way too far with the mandate. This, they say, is the first time the government is making people buy a commercial product they may not want. That's a huge overreach, they contend.
Just take a look at the very start of the brief .. http://www.kaiserhealthnews.org/~/media/Files/2012/11398bsStatesMinimumCoverageProvision.pdf .. filed by Paul Clement, .. http://www.npr.org/2012/03/23/149218361/the-legal-wunderkind-challenging-the-health-law .. the legal wunderkind who is leading the challenge by 26 states to the overhaul law:
"The individual mandate rests on a claim of federal power that is both unprecedented and unbounded: the power to compel individuals to engage in commerce in order more effectively to regulate commerce. This asserted power does not exist."
After Clement finished his arguments along those lines, SCOTUSblog's Tom Goldstein left the courtroom to file an update, saying, .. http://www.scotusblog.com/2012/03/audio-update-from-tom/ .. "The individual mandate is in trouble — significant trouble. It's too early to tell whether it will be struck down."
Still, it's clear that the court's conservative justices are "quite skeptical." And Goldstein said, "Paul Clement gave the best argument of any kind that I've ever heard."
In order to survive, the individual mandate will need to be upheld by the high court's four liberal justices and at least one of its five conservative justices. In the lead up to this week's hearings, some had speculated that the votes of Chief Justice John Roberts, Justice Antonin Scalia and Justice Anthony Kennedy might be in play. But during Tuesday's arguments, Scalia, at least, was clearly leaning toward striking down the mandate, Totenberg says.
Solicitor General Donald B. Verrilli Jr. .. http://www.npr.org/2012/03/22/148947199/the-man-behind-the-defense-of-obamas-health-law .. was first up Tuesday, and he got his fill of tough questions.
Justice Anthony Kennedy, often a swing vote, pressed Verrilli with questions about the mandate and what limits there might be on the federal government's power to compel people to do certain things, such as buy particular foods.
Kennedy said the government faces a "very heavy burden of justification" for the mandate, The Wall Street Journal's Louise Radnofsky reported during .. http://blogs.wsj.com/washwire/2012/03/27/live-blog-obama-health-law-at-the-supreme-court-day-2/ .. the arguments.
Verrilli says that with the overhaul, Congress is regulating people's participation in the existing market for health care, not treading in brand-new territory. Liberal justices Ruth Bader Ginsburg and Stephen Breyer appeared to back him up on that.
But conservative justices remained skeptical. If the court lets the mandate stand, it may be difficult to limit what Congress can do on other fronts, Chief Justice John Roberts said, according to the Journal's Brent Kendall. "All bets are off," Roberts reportedly said.
At one point, according to the Journal, Justice Samuel Alito asked Verrilli, "Could you express your limiting principle as succinctly as you possibly can?"
As things stand now, about 26 million uninsured people in the U.S. could be subject to the mandate, according to an analysis .. http://www.rwjf.org/pr/product.jsp?id=74120 .. by the Urban Institute released Monday. But about 8 million of them would be eligible for Medicaid or health insurance programs for children that wouldn't cost them much, if anything. Nearly 11 million would be eligible for subsidies under the law. And only about 7 million people would be subject to the mandate and not get some help paying for coverage.
The so-called individual mandate aims to make health insurance nearly universal. With just about everyone in the health insurance pool, the financial risks would spread out among a lot more people.
Supporters of the mandate say those economics are essential to making other changes under the health law, such as a ban on insurers discriminating against people with pre-existing medical conditions. Near-universal coverage would also help make possible a requirement that insurance companies generally charge about the same amount for people who are about the same age.
In briefs and during Tuesday's arguments, the government has countered that health care represents a unique market. Everyone at some point will get health care. The real questions are when they will get it, and who pays for it?
The mandate, say the supporters, is the best way to make sure that everyone pays his or her fair share. As former Clinton administration Solicitor General Walter Dellinger put it to .. http://www.npr.org/blogs/health/2012/03/27/149242939/justices-tackle-the-big-question-can-congress-force-you-to-buy-insurance .. Totenberg before the arguments:
"Look, if I don't buy a flat-screen television, and my team is playing for the national championship, I don't get to run into Best Buy and say, 'You gotta give me a flat-screen television.' But I do get to go to a hospital when I'm sick and have people provide me with services."
What's more, the federal government has argued that the law falls well within its constitutional powers to regulate commerce and to levy taxes. While lower courts have split, one conservative appeals court judge wrote last year .. http://www.npr.org/blogs/health/2011/06/29/137501931/federal-appeals-court-upholds-health-overhaul-law .. in an opinion that went the administration's way:
"Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life. Not every intrusive law is an unconstitutionally intrusive law."
In a few months we'll learn how many — or how few — of the justices see it that way.
http://www.npr.org/blogs/health/2012/03/26/149417437/high-court-justices-appear-split-on-insurance-mandate
========
Brad DeLong
Grasping Reality with the Invisible Hand
Fair, Balanced, and Reality-Based
Dr. Jen Gunter: Cancer v. the Constitution
March 30, 2012
Twice as much money spent on health care as your typical North Atlantic country. Three years less in life expectancy. High-education 25-year old white women with a life expectancy 8.6 years longer than low-education 25-year old African-American women.
And this is why:
Jen Gunter:
Cancer v. the Constitution « Dr. Jen Gunter:
http://drjengunter.wordpress.com/2012/03/28/cancer-v-the-constitution/
The patient in the emergency department smelled of advanced
cancer. It is the smell of rotting flesh, but even more pungent.
You only ever have to smell it once.
She had been bleeding irregularly, but chalked it up to “the change.” Peri-menopausal hormonal mayhem is the most common cause of irregular vaginal bleeding, but unfortunately not the only cause.
She hadn’t gone to the doctor because she had no health insurance. The only kind of work she could get in a struggling rural community was without benefits. Her coat and shoes beside the gurney were worn and her purse from another decade. She could never afford to buy it on her own. She didn’t qualify for Medicaid, the local doctor only took insurance, and there was no Planned Parenthood or County Clinic nearby.
So nothing was done about the bleeding until she passed out at work and someone called an ambulance. She required a couple of units of blood at the local hospital before they sent her by ambulance to our emergency department.
I looked at the fungating mass on her cervix. Later the Intern wondered why she hadn’t picked up on the smell. Probably a combination of it being so gradual and denial. It’s amazing what people learn to tolerate when their options are limited.
“I’m very sorry to tell you this looks like a cancer of the cervix,” I said
She looked surprised. “Oh.” She paused in silence as she adjusted to the news. And then quietly she added, “But the doctor back home said you could fix me up. He said you can offer free care because you have the university.”
But we didn’t have free care at the university hospital. While resident salaries come from Medicare dollars, there is very little, if any, money from the State for the medically indigent. We were in the same situation as her local OB/GYN. The cost of caring for those without insurance was born by the profits from those with insurance. But medical care was becoming more expensive and what insurance companies were willing to reimburse was decreasing. In addition, with more unemployment there were fewer insured patients and more uninsured. Not a sustainable model.
She needed a biopsy to confirm the type of cancer and a CT scan to see if the tumor had spread beyond the cervix. If she were lucky, she would have a some combination of a hysterectomy, chemotherapy, and radiation with a 50-65% chance of survival. If the cancer had spread, she would have radiation and chemotherapy with about a 25% chance of surviving.
But the cancer surgeons were not allowed to offer an uninsured woman a hysterectomy. Every now and then they snuck someone in, claiming to the administrators that the patient was more emergent than they really were. But one surgery doesn’t cure stage 2 or 3 cervical cancer, or even stave it off for long. It takes multiple admissions and week after week of expensive chemotherapy and/or radiation.
The radiation doctors were also not allowed to see uninsured patients. They could not even give a dying women a few weeks of radiation to ease her tumor’s stench while it caused her to bleed to death or killed her another way. They could give her one dose today. A very temporary measure for the bleeding, but only if her blood count was low enough. It wasn’t because she’s had the blood transfusion to get her here.
There was a charity program that paid providers and hospitals pennies on the dollar for cancer care. One hospital had signed up, resigned to the fact that they were seeing those patients anyway so better to get something for the cost of the care than nothing. Our hospital administrators had declined to participate. Better to get no money and keep seeing these uninsured patients over and over in the emergency room, each time providing the same stop-gap care that has no hope of cure or even palliation like a purgatory version of Groundhog Day, than to be inadequately reimbursed for the right care.
I had never encountered this clinical scenario during my training in Canada. I had never seen a woman suffer because she couldn’t afford something as simple as a Pap smear, never mind deal with the indignities of shopping around her sorrow and hard luck to try to patch together what would inevitably be inadequate medical therapy. It is this reality of medical care in America for which I was wholly unprepared. Many times I found the residents comforting me.
I gathered my thoughts before explaining the situation. To get her care through the charity program there was a catch. A set of hoops to jump through and we could jeopardize her eligibility with specific tests. I explained the ins and outs of accessing care through the program, where she needed to go, and what specifically she must say. The Intern printed out the sheet of community resources and advocacy groups that might also be able to help her patch together some kind of treatment.
It’s not health care, not by any stretch. But as long as the Supreme Court finds it constitutional I guess they’ll sleep better than I do.
http://delong.typepad.com/sdj/2012/03/dr-jen-gunter-cancer-v-the-constitution.html
It's not hard to imagine why Brad colored Dr. Jen Gunter's story blue.
See also:
HEALTHCARE REPUBLICAN/TEA PARTY STYLE......
http://investorshub.advfn.com/boards/read_msg.aspx?message_id=73884148
Health Care Jujitsu .. excerpt ..
So why not Medicare for all?
Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan's plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government's authority.
Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.
When this happens, Obama and the Democrats should say they're willing to remove
that requirement - but only if Medicare is available to all, financed by payroll taxes.
If they did this the public will be behind them -- as will the Supreme Court.
http://investorshub.advfn.com/boards/read_msg.aspx?message_id=73753537
by Scott Hensley .. 12:27 pm .. March 27, 2012
John Rose/NPR
Supporters and opponents of the health care law rallied in front of the Supreme Court
Tuesday, as the court considered the constitutionality of the insurance mandate.
Today's arguments hit the core of the Affordable Care Act: the mandate that
requires just about everyone to have health insurance starting in 2014.
Special Coverage .. [two of] .. Supreme Court Arguments
http://www.npr.org/series/148920753/judging-the-health-care-law
Nina Totenberg: Mandate's Fate Seems To Rest On Kennedy, Roberts
http://www.npr.org/2012/03/27/149480728/supreme-court-justices-weight-mandate
And the U.S. Supreme Court's justices appeared split on whether the federal government can force people to buy health insurance. The court's conservatives appeared skeptical and unmoved by the government's arguments in favor of the mandate.
"The government had a hard time, and if they win, they win narrowly," NPR's Nina Totenberg reported from outside the court. "I don't think you can call this."
The law says that if you're not covered by Medicare, Medicaid or insurance provided by your employer, then you'll have to pony up for coverage on your own or pay a fine.
Those challenging the law say the federal government is going way too far with the mandate. This, they say, is the first time the government is making people buy a commercial product they may not want. That's a huge overreach, they contend.
Just take a look at the very start of the brief .. http://www.kaiserhealthnews.org/~/media/Files/2012/11398bsStatesMinimumCoverageProvision.pdf .. filed by Paul Clement, .. http://www.npr.org/2012/03/23/149218361/the-legal-wunderkind-challenging-the-health-law .. the legal wunderkind who is leading the challenge by 26 states to the overhaul law:
"The individual mandate rests on a claim of federal power that is both unprecedented and unbounded: the power to compel individuals to engage in commerce in order more effectively to regulate commerce. This asserted power does not exist."
After Clement finished his arguments along those lines, SCOTUSblog's Tom Goldstein left the courtroom to file an update, saying, .. http://www.scotusblog.com/2012/03/audio-update-from-tom/ .. "The individual mandate is in trouble — significant trouble. It's too early to tell whether it will be struck down."
Still, it's clear that the court's conservative justices are "quite skeptical." And Goldstein said, "Paul Clement gave the best argument of any kind that I've ever heard."
In order to survive, the individual mandate will need to be upheld by the high court's four liberal justices and at least one of its five conservative justices. In the lead up to this week's hearings, some had speculated that the votes of Chief Justice John Roberts, Justice Antonin Scalia and Justice Anthony Kennedy might be in play. But during Tuesday's arguments, Scalia, at least, was clearly leaning toward striking down the mandate, Totenberg says.
Solicitor General Donald B. Verrilli Jr. .. http://www.npr.org/2012/03/22/148947199/the-man-behind-the-defense-of-obamas-health-law .. was first up Tuesday, and he got his fill of tough questions.
Justice Anthony Kennedy, often a swing vote, pressed Verrilli with questions about the mandate and what limits there might be on the federal government's power to compel people to do certain things, such as buy particular foods.
Kennedy said the government faces a "very heavy burden of justification" for the mandate, The Wall Street Journal's Louise Radnofsky reported during .. http://blogs.wsj.com/washwire/2012/03/27/live-blog-obama-health-law-at-the-supreme-court-day-2/ .. the arguments.
Verrilli says that with the overhaul, Congress is regulating people's participation in the existing market for health care, not treading in brand-new territory. Liberal justices Ruth Bader Ginsburg and Stephen Breyer appeared to back him up on that.
But conservative justices remained skeptical. If the court lets the mandate stand, it may be difficult to limit what Congress can do on other fronts, Chief Justice John Roberts said, according to the Journal's Brent Kendall. "All bets are off," Roberts reportedly said.
At one point, according to the Journal, Justice Samuel Alito asked Verrilli, "Could you express your limiting principle as succinctly as you possibly can?"
As things stand now, about 26 million uninsured people in the U.S. could be subject to the mandate, according to an analysis .. http://www.rwjf.org/pr/product.jsp?id=74120 .. by the Urban Institute released Monday. But about 8 million of them would be eligible for Medicaid or health insurance programs for children that wouldn't cost them much, if anything. Nearly 11 million would be eligible for subsidies under the law. And only about 7 million people would be subject to the mandate and not get some help paying for coverage.
The so-called individual mandate aims to make health insurance nearly universal. With just about everyone in the health insurance pool, the financial risks would spread out among a lot more people.
Supporters of the mandate say those economics are essential to making other changes under the health law, such as a ban on insurers discriminating against people with pre-existing medical conditions. Near-universal coverage would also help make possible a requirement that insurance companies generally charge about the same amount for people who are about the same age.
In briefs and during Tuesday's arguments, the government has countered that health care represents a unique market. Everyone at some point will get health care. The real questions are when they will get it, and who pays for it?
The mandate, say the supporters, is the best way to make sure that everyone pays his or her fair share. As former Clinton administration Solicitor General Walter Dellinger put it to .. http://www.npr.org/blogs/health/2012/03/27/149242939/justices-tackle-the-big-question-can-congress-force-you-to-buy-insurance .. Totenberg before the arguments:
"Look, if I don't buy a flat-screen television, and my team is playing for the national championship, I don't get to run into Best Buy and say, 'You gotta give me a flat-screen television.' But I do get to go to a hospital when I'm sick and have people provide me with services."
What's more, the federal government has argued that the law falls well within its constitutional powers to regulate commerce and to levy taxes. While lower courts have split, one conservative appeals court judge wrote last year .. http://www.npr.org/blogs/health/2011/06/29/137501931/federal-appeals-court-upholds-health-overhaul-law .. in an opinion that went the administration's way:
"Regulating how citizens pay for what they already receive (health care), never quite know when they will need, and in the case of severe illnesses or emergencies generally will not be able to afford, has few (if any) parallels in modern life. Not every intrusive law is an unconstitutionally intrusive law."
In a few months we'll learn how many — or how few — of the justices see it that way.
http://www.npr.org/blogs/health/2012/03/26/149417437/high-court-justices-appear-split-on-insurance-mandate
========
Brad DeLong
Grasping Reality with the Invisible Hand
Fair, Balanced, and Reality-Based
Dr. Jen Gunter: Cancer v. the Constitution
March 30, 2012
Twice as much money spent on health care as your typical North Atlantic country. Three years less in life expectancy. High-education 25-year old white women with a life expectancy 8.6 years longer than low-education 25-year old African-American women.
And this is why:
Jen Gunter:
Cancer v. the Constitution « Dr. Jen Gunter:
http://drjengunter.wordpress.com/2012/03/28/cancer-v-the-constitution/
The patient in the emergency department smelled of advanced
cancer. It is the smell of rotting flesh, but even more pungent.
You only ever have to smell it once.
She had been bleeding irregularly, but chalked it up to “the change.” Peri-menopausal hormonal mayhem is the most common cause of irregular vaginal bleeding, but unfortunately not the only cause.
She hadn’t gone to the doctor because she had no health insurance. The only kind of work she could get in a struggling rural community was without benefits. Her coat and shoes beside the gurney were worn and her purse from another decade. She could never afford to buy it on her own. She didn’t qualify for Medicaid, the local doctor only took insurance, and there was no Planned Parenthood or County Clinic nearby.
So nothing was done about the bleeding until she passed out at work and someone called an ambulance. She required a couple of units of blood at the local hospital before they sent her by ambulance to our emergency department.
I looked at the fungating mass on her cervix. Later the Intern wondered why she hadn’t picked up on the smell. Probably a combination of it being so gradual and denial. It’s amazing what people learn to tolerate when their options are limited.
“I’m very sorry to tell you this looks like a cancer of the cervix,” I said
She looked surprised. “Oh.” She paused in silence as she adjusted to the news. And then quietly she added, “But the doctor back home said you could fix me up. He said you can offer free care because you have the university.”
But we didn’t have free care at the university hospital. While resident salaries come from Medicare dollars, there is very little, if any, money from the State for the medically indigent. We were in the same situation as her local OB/GYN. The cost of caring for those without insurance was born by the profits from those with insurance. But medical care was becoming more expensive and what insurance companies were willing to reimburse was decreasing. In addition, with more unemployment there were fewer insured patients and more uninsured. Not a sustainable model.
She needed a biopsy to confirm the type of cancer and a CT scan to see if the tumor had spread beyond the cervix. If she were lucky, she would have a some combination of a hysterectomy, chemotherapy, and radiation with a 50-65% chance of survival. If the cancer had spread, she would have radiation and chemotherapy with about a 25% chance of surviving.
But the cancer surgeons were not allowed to offer an uninsured woman a hysterectomy. Every now and then they snuck someone in, claiming to the administrators that the patient was more emergent than they really were. But one surgery doesn’t cure stage 2 or 3 cervical cancer, or even stave it off for long. It takes multiple admissions and week after week of expensive chemotherapy and/or radiation.
The radiation doctors were also not allowed to see uninsured patients. They could not even give a dying women a few weeks of radiation to ease her tumor’s stench while it caused her to bleed to death or killed her another way. They could give her one dose today. A very temporary measure for the bleeding, but only if her blood count was low enough. It wasn’t because she’s had the blood transfusion to get her here.
There was a charity program that paid providers and hospitals pennies on the dollar for cancer care. One hospital had signed up, resigned to the fact that they were seeing those patients anyway so better to get something for the cost of the care than nothing. Our hospital administrators had declined to participate. Better to get no money and keep seeing these uninsured patients over and over in the emergency room, each time providing the same stop-gap care that has no hope of cure or even palliation like a purgatory version of Groundhog Day, than to be inadequately reimbursed for the right care.
I had never encountered this clinical scenario during my training in Canada. I had never seen a woman suffer because she couldn’t afford something as simple as a Pap smear, never mind deal with the indignities of shopping around her sorrow and hard luck to try to patch together what would inevitably be inadequate medical therapy. It is this reality of medical care in America for which I was wholly unprepared. Many times I found the residents comforting me.
I gathered my thoughts before explaining the situation. To get her care through the charity program there was a catch. A set of hoops to jump through and we could jeopardize her eligibility with specific tests. I explained the ins and outs of accessing care through the program, where she needed to go, and what specifically she must say. The Intern printed out the sheet of community resources and advocacy groups that might also be able to help her patch together some kind of treatment.
It’s not health care, not by any stretch. But as long as the Supreme Court finds it constitutional I guess they’ll sleep better than I do.
http://delong.typepad.com/sdj/2012/03/dr-jen-gunter-cancer-v-the-constitution.html
It's not hard to imagine why Brad colored Dr. Jen Gunter's story blue.
See also:
HEALTHCARE REPUBLICAN/TEA PARTY STYLE......
http://investorshub.advfn.com/boards/read_msg.aspx?message_id=73884148
Health Care Jujitsu .. excerpt ..
So why not Medicare for all?
Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan's plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government's authority.
Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.
When this happens, Obama and the Democrats should say they're willing to remove
that requirement - but only if Medicare is available to all, financed by payroll taxes.
If they did this the public will be behind them -- as will the Supreme Court.
http://investorshub.advfn.com/boards/read_msg.aspx?message_id=73753537
It was Plato who said, “He, O men, is the wisest, who like Socrates, knows that his wisdom is in truth worth nothing”
Discover What Traders Are Watching
Explore small cap ideas before they hit the headlines.
