Patient Protection and Affordable Care Act PPACA aka Obamacare

[Uncle Punk]

Things are about to get fun and interesting. Both sides have their game faces on and are pulling no punches.

I suspect the court will rule 5-4 on the individual mandate but there are a whole lot of possibilities for what that might mean, if they even hear the case this early. Cause may not take place until 2014 and this could just be tabled.

First the Obama administration announces this.

http://content.usatoday.com/communities/theoval/post/2011/09/obama-to-ask-supreme-court-to-hear-health-care-case/1

Then this comes out. (Well played.)

http://www.cbsnews.com/8301-503544_162-20113883-503544.html

Set to be heard here

http://www.scotusblog.com/2011/10/health-cases-set/

The state right-to-sue issue could come up, Verrilli said, depending upon how the Court rules upon the potential impact on the mandate challenges of the federal Anti-Injunction Act.

That is a law that bars any court challenge to a federal tax provision before it actually goes into effect. The Fourth Circuit, in a ruling separate from its decision on Virginia’s right to sue, had concluded that the Anti-Injunction Act bars the challenges to the mandate, on the premise that it is a federal tax provision. In the 26 states’ petition, they argue that that Act does not apply to states. While disagreeing with that argument, the Solicitor General said, the Court’s discussion of the scope of that Act’s reach might implicate the question of state standing to sue.

http://www.scotusblog.com/2011/11/virginia-challenged-on-health-care/#more-131165

[Scruit]

Genuine question - not making a political point... We are already required to have car insurance and it is commonly accepted that those who do not have such insurance are an undue burden on the people as a whole - what is the difference between that and requiring us to have health insurance?

Just like car insruance, you should be able to file a certificate of self-insurance if you have the assets to pay for your own healthcare if needed. But if you cannot afford to pay for your health care then that's just like not being able to paty for damages you cause in a crash - hence why we are required to buy car insurance?

How much cheaper would *my* car insurance be if I wasn't also subsidizing the damages caused by the uninsured? Therefore, how much cheaper would my health insurance be if I wasn't subsidizing the health costs of the uninsured?

[NinjaDoc]

Genuine question - not making a political point... We are already required to have car insurance and it is commonly accepted that those who do not have such insurance are an undue burden on the people as a whole - what is the difference between that and requiring us to have health insurance?

i have no political knowledge of whats going on here, or whats gonna happen or even what the health bill is all about. But this question is what i always had doubt myself. What i am about to say is just what i see and not my biased opinion.

Since we cover non insured patients coming into hospital everyday, i see in first person how much of money is going down the drain. Its not the fees and cost, its the defensive practice. non insured guy walks in fully drunk with no medical problems. He still gets admitted and gets at least the basic lab work done and a CT of head if he was found floored on the streets. By the end of the day 500-1000 dollars from tax payers is gone on this one guy in few hours coz he decided to just have a fiesta.

[crb]

Genuine question - not making a political point... We are already required to have car insurance and it is commonly accepted that those who do not have such insurance are an undue burden on the people as a whole - what is the difference between that and requiring us to have health insurance?

Just like car insruance, you should be able to file a certificate of self-insurance if you have the assets to pay for your own healthcare if needed. But if you cannot afford to pay for your health care then that's just like not being able to paty for damages you cause in a crash - hence why we are required to buy car insurance?

How much cheaper would *my* car insurance be if I wasn't also subsidizing the damages caused by the uninsured? Therefore, how much cheaper would my health insurance be if I wasn't subsidizing the health costs of the uninsured?

First the car insurance mandate is at the state level, and secondly you are not required to own a car. Basically you have an option don't own a car and your not required to carry car insurance.

[Scruit]

Why does it matter? When did it become 'ok' for any level of government to mandate the purchase of any food/service?

Trash pickup is private where I am. I'm sure if I refused to engage a trash service I'd find out quick enough that the government can make me purchase it.

[conn-e-rot]

Eh don't worry in a few years when were all speaking Chinese your health insurance won't matter.

[r1crusher]

Eh don't worry in a few years when were all speaking Chinese your health insurance won't matter.

Or Spanish....take your pick.

[Scruit]

Only if you're trash started to become a nuisance. What if you burned your refuse? Should you be forced to buy trash collection?

What if my HSA/HDHP isn't an "allowable insurance option"? Should I be forced to buy another opion because the FedGov says so? I like my insurance plan' date=' no matter how unorthodox it may seem to others. Stay out of my personal finances/business.[/quote']

Burning is illegal under EPA rules. Can't bury either. Have to take it away. My options are to purchase trash collection or drive it to the dump myself.

How nice would it be if your insurance cost half as much because your insurance didn't need to spend as much on health care costs because everyone paid their own way. Better than the hospitals giving out free care and charging the rest of us extra to cover it.

[conn-e-rot]

How nice would it be if when you had injured your ankle they put your name a waiting list for xray and sent you home and 3 weeks later you got the call to come in for xray and then they say oh well its broken but it started to heal wrong so now you need surgery so we'll put your name on the list for surgery and 6 months later you get that surgery

[Casper]

Things are about to get fun and interesting. Both sides have their game faces on and are pulling no punches.

I suspect the court will rule 5-4 on the individual mandate but there are a whole lot of possibilities for what that might mean, if they even hear the case this early. Cause may not take place until 2014 and this could just be tabled.

First the Obama administration announces this.

http://content.usatoday.com/communities/theoval/post/2011/09/obama-to-ask-supreme-court-to-hear-health-care-case/1

Then this comes out. (Well played.)

http://www.cbsnews.com/8301-503544_162-20113883-503544.html

Set to be heard here

http://www.scotusblog.com/2011/10/health-cases-set/

http://www.scotusblog.com/2011/11/virginia-challenged-on-health-care/#more-131165

She made $700,000 in four years works for a non-profit!?

[Scruit]

How nice would it be if when you had injured your ankle they put your name a waiting list for xray and sent you home and 3 weeks later you got the call to come in for xray and then they say oh well its broken but it started to heal wrong so now you need surgery so we'll put your name on the list for surgery and 6 months later you get that surgery

Don't forget I've lived under a socialised health care system so you can't BS me on how it works.

Direct parallel #1: Broken nose. I've had a broken nose in the UK and one in the US. Both required closed reduction surgery.

US: Went to emergency room. Was there for 3 hours. Given MRI and told to go to an ENT. Booked with an ENT, 3 days later was earliest appointment. ENT recommended suregry and booked me in a week later. Outpatient. Total of all charges was $8,000. I was $5000 out of pocket due to deductible, co-pays and 90% coverage.

UK: Went to emergency room. Was there for 3 hours. ENT on staff recommended surgery. Booked in 3 days later. Outpatient. Out of pocket cost was zero.

Direct Parallel #2: Ambulance hospitalization. Once in the UK, once in the US. Both me, both for same reason.

US: 911 called, ambulance arrived 10 minutes later. Basic tests performed on-scene, transported out of house on a chair, moved to stretcher, into ambulance. Arrived at hospital 20 minutes later. Admitted to ER and placed in room. Testing included blood tests, functional tests and ultrasound. Released 4 hours later and told no cause was found and I was apparently better now. Cost of hospitalization was $3200, about $1000 of that was out-of-pocket.

UK: 999 called. Paramedic arrived 10 minutes later. Basic tests performed on-scene, transported out of house on a chair, moved to stretcher, into ambulance. Arrived at hospital 20 minutes later. Admitted to ER and placed in room. Testing included blood tests, functional tests. Told no cause was found and I was apparently better now, so kept for observation for 2 days for further testing. Isotopic brain scan, MRI, and other tests performed over the next 6 weeks. All ruled out a more serious cause for the hospitalization. Told to follow up with family doctor if anything else was noted. Out-of-pocket cost of hospitalization was zero.

Direct Parallel #3:

US: 6yo Child diagnosed with AML (leukemia). (Child of a co-worker - I worked as a fundraiser for his hospital costs). Treated at the hosptial, total bills by the time the AML went into remission came to over $5 MILLION dollars. Insurance paid out $1m and then said; "Lifetime max!" and went away. Parents left with $4m in bills. Declared bankruptcy and lost their house. Family of 4 went to live in a 1-bed apt. Took them 10 years to recover financially.

UK: 10yo child diagnosed with Craniopharyngioma (Brain tumor) (My brother). The NHS did the tumour removal surgery within a week of the tumor's discovery. Operation took alomost 9 hours, he was hospitalized for weeks and then scheduled for 18 months of 2x a wk radiotherapy (like chemo but uses radiation to target remaiing tumor cells instead of drugs) at Weston Park Cancer Hospital in Sheffield, including transportation. Total out of pocket for everything - Zero.

You can't BS with with dire predictions of socialist medicine, because I know what it is REALLY like.

Edited November 8, 2011 by Scruit

[Scruit]

Goddamn' date=' I hate this fucking iPod.

Points:

-not wise to give politicians say-so in our health insurance, as lobbyists advise them on what's best for us

-the cost won't go down. Trade one tax for another tax. What's the difference?

-

my premium is <$125/month. That covers me and Lyns. I'd appreciate it of the rest of you wouldn't sign of on the government fucking that up for me.[/quote']

Talk to an ER nurse. Uninsured people come to the ER with a COLD and demand tylenol. And they have to be treated by law. And the when the $2500 bill doesn't get paid by them - the hospital rolls it into the charges they charge your health insurance, who rolls it into your premiums.

If these people had insurance they could pay $20 and go to their doctor. Cost of treatment is $100 not $2500.

THAT is where the savings are.

(not to mention uninsured people will ignore a treatable health condition until it's life threatening, so the unpaid bill is massive compared to the cost of treating early)

[conn-e-rot]

Well then if it's so good maybe more people should move over to that side of the pond and leave us red blooded stubborn Americans to decide if we want health insurance or not on our own.

[NinjaDoc]

Talk to an ER nurse. Uninsured people come to the ER with a COLD and demand tylenol. And they have to be treated by law. And the when the $2500 bill doesn't get paid by them - the hospital rolls it into the charges they charge your health insurance, who rolls it into your premiums.

If these people had insurance they could pay $20 and go to their doctor. Cost of treatment is $100 not $2500.

THAT is where the savings are.

(not to mention uninsured people will ignore a treatable health condition until it's life threatening, so the unpaid bill is massive compared to the cost of treating early)

true,

People walk in with fever and say cant afford tylenol, on history they smoke 3 packs of cigs every day and afford that pretty easy.

Not to mention the coke and heroin junkies who all feed on hard working peoples tax and life insurance.

[Mykill]

Talk to an ER nurse. Uninsured people come to the ER with a COLD and demand tylenol. And they have to be treated by law. And the when the $2500 bill doesn't get paid by them - the hospital rolls it into the charges they charge your health insurance, who rolls it into your premiums.

If these people had insurance they could pay $20 and go to their doctor. Cost of treatment is $100 not $2500.

THAT is where the savings are.

(not to mention uninsured people will ignore a treatable health condition until it's life threatening, so the unpaid bill is massive compared to the cost of treating early)

Your surprisingly spot on but its not tylenol is dilaudid and they tell NinjaDoc the dose.

did you know you cant get evicted because you are in a hospital...... chest pain = free rent. : )

Edited November 8, 2011 by Mykill

[conn-e-rot]

So quit giving the free loaders a free ride but don't let the government decide if IP's insurance is good enough for him or not that is his choice remember this is still United States of America not United States of China

[drew95gt]

i have no political knowledge of whats going on here, or whats gonna happen or even what the health bill is all about. But this question is what i always had doubt myself. What i am about to say is just what i see and not my biased opinion.

Since we cover non insured patients coming into hospital everyday, i see in first person how much of money is going down the drain. Its not the fees and cost, its the defensive practice. non insured guy walks in fully drunk with no medical problems. He still gets admitted and gets at least the basic lab work done and a CT of head if he was found floored on the streets. By the end of the day 500-1000 dollars from tax payers is gone on this one guy in few hours coz he decided to just have a fiesta.

I see the same thing everyday @ work, it's both sad and frustrating at the same time. Then, they bitch about the service they get 9 out of 10 times as well. I'm not sure about the healthcare bill...I have a feeling the middle class will still end up footing the bill for these folks same as we always have. I'm not sure more regulation is the answer here.

[Scruit]

Well then if it's so good maybe more people should move over to that side of the pond and leave us red blooded stubborn Americans to decide if we want health insurance or not on our own.

Direct parallel #4 - Broken ankle.

US: (me). Skipped ER because I knew they'd charge me $2500 and just tell me my ankle was broken and to see an ortho. Went direct to ortho instead the next day. Ortho sent me for MRI, decided on non-surgical treatment. 9 weeks of physio. Total cost of care $5000. Out of pocket for me was $2000. Would have been $2500 higher if I went to ER.

UK: (mother). Went to ER with a Tri-malleolar fracture of her ankle (much more serious injury than mine). Admitted immediately. Surgery recommended and scheduled for the next day. Pins/plates installed. Kept for a week, then released to 6 mounths of outpatient care and physiotherapy. Out of pocket cost was zero.

Just remember, when someone declines health insurance and then can't pay their bills, the rest of us pay for it. I wish I had the right to quit paying all my bills and have everyone else pay them instead.

[drew95gt]

true,

People walk in with fever and say cant afford tylenol, on history they smoke 3 packs of cigs every day and afford that pretty easy.

Not to mention the coke and heroin junkies who all feed on hard working peoples tax and life insurance.

This is also true. We see so many COPD patients come in that refuse to quit smoking, have no insurance, and end up with respiratory failure being put on the vent for days if not weeks (at the cost of at least a grand a day for the ventilator...not counting the ICU stay plus meds and various consults). That is a HUGE amount of money, and these folks are "regulars"...as in, I am on a first name basis with many of them that come through ER.

Edited November 8, 2011 by drew95gt

[NinjaDoc]

yea like i said, i have no idea how the bill works, its just if we could find a solution for this problem things would be so much better.

99 out of 100 guys who walk in is bull crap, but one guy who cant afford the insurance is genuinely in need of medical attention. His life is saved because of the other tax paying working class which cannot be valued in any terms, so we cant fully deny any free loaders because its simply inhuman.

This is a concrete problem for which solution is going to be complex, then again this is the story of life every where in the world.

[conn-e-rot]

Direct Parallel #3:

US: 6yo Child diagnosed with AML (leukemia). (Child of a co-worker - I worked as a fundraiser for his hospital costs). Treated at the hosptial, total bills by the time the AML went into remission came to over $5 MILLION dollars. Insurance paid out $1m and then said; "Lifetime max!" and went away. Parents left with $4m in bills. Declared bankruptcy and lost their house. Family of 4 went to live in a 1-bed apt. Took them 10 years to recover financially.

UK: 10yo child diagnosed with Craniopharyngioma (Brain tumor) (My brother). The NHS did the tumour removal surgery within a week of the tumor's discovery. Operation took alomost 9 hours, he was hospitalized for weeks and then scheduled for 18 months of 2x a wk radiotherapy (like chemo but uses radiation to target remaiing tumor cells instead of drugs) at Weston Park Cancer Hospital in Sheffield, including transportation. Total out of pocket for everything - Zero.

You can't BS with with dire predictions of socialist medicine, because I know what it is REALLY like.

That is what's sad in this country if those parents had been on welfare that child's bills would have been paid but since they work and provide for their family they get screwed.

[Scruit]

That is what's sad in this country if those parents had been on welfare that child's bills would have been paid but since they work and provide for their family they get screwed.

Sucks thair their insurance can bail out like that. Insurance should be all -or-nothing with no maximum.

I've heard "But the insurance company can't afford $4m forevery patient!" What makes us think the parents can afford it??

[conn-e-rot]

I don't know the solution but government mandated insurance is not the answer those idiots in Washington already have too much power

While were on this subject when your in the hospital how the doctors justify charging you several hundred dollars to walk into your room say hi maybe look at your chart and walk out?

[conn-e-rot]

Sucks thair their insurance can bail out like that. Insurance should be all -or-nothing with no maximum.

I've heard "But the insurance company can't afford $4m forevery patient!" What makes us think the parents can afford it??

It's the same with home owners insurance you need flood insurance and sewer back up insurance and all this other BS and then if they don't want to pay they say well it's not covered because it was an act of god.

[Strictly Street]

Genuine question - not making a political point... We are already required to have car insurance and it is commonly accepted that those who do not have such insurance are an undue burden on the people as a whole - what is the difference between that and requiring us to have health insurance?

Not the same thing, don't fall into this argument. You are not required to have a car by law.

So not all people have to buy insurance. It's not a comparable analogy. Apples and Oranges.

Just like car insurance, you should be able to file a certificate of self-insurance if you have the assets to pay for your own healthcare if needed. But if you cannot afford to pay for your health care then that's just like not being able to pay for damages you cause in a crash - hence why we are required to buy car insurance?

I have no idea if you could do that but I do know that if you are politically connected you can get a waiver.

Pelosi admitted that some 2000 companies had received waivers but that it was OK because they were all small companies.

A comment that doesn't seem to make any sense on it's face.

If it is so crushing to small business that they need a waiver to survive why is it ok for the bigger companies to shoulder such a crushing cost.

How much cheaper would *my* car insurance be if I wasn't also subsidizing the damages caused by the uninsured? Therefore, how much cheaper would my health insurance be if I wasn't subsidizing the health costs of the uninsured?

I'm thinking my un-insured motorist coverage is about $30/yr or some such thing. So the answer is not very much.

When it comes to healthcare what used to cost me $30 a pay now tops out at over $100.

I cannot shoulder the expense. It now costs more than my rent.

The health care bill has priced health care out of my reach.