The Supreme Court and Healthcare Mandates

[PrincessFiona]

I'd love to hear what you all think about this going before the Supreme Court as well as your guesses about whether it is found to be unconstitutional or not. I have been so busy with the kids that I haven't had much time to read about this in depth.

While we're on the topic, how do you think the new healthcare law is going to affect healthcare in general as well as physician compensation?

Kris

[GrayMatterWife]

The Supremes ain't buying the "it's a tax that has yet to be imposed" argument, so they most likely will not punt. That was clear.

I bet if they can get more than a 5-4 split, they''ll strike down only the individual mandate and leave the rest standing, to be sorted out by Congress. I doubt the Court would want to kill huge a huge piece of legislation in toto, without something other than a party-line split based on the party who appOinted the justices. They are still feeling the distrust that the 5-4 Bush v Gore split engendered.

But what do I know. Maybe they'll say, sure, tr Commerce Clauae allows the Feds to do this--we aren't the ones to undo it--you need to go through a Congressional appeal.

[diggitydot]

The individual mandate idea was initially created by The Heritage Foundation and is a boon to insurers' bottom lines (and implemented as part of their negotiations) since it adds millions of young, healthy consumers to their risk pools.

I'm really interested to see how this plays out.

ETA: I just recently found out that a guy I went to high school with is a big wig at The Heritage Foundation. Who says the PNW is only good for hippies?

[oceanchild]

DH is pretty confident they'll strike down the individual mandate. Which, obviously, will make the rest of the law really difficult to follow. I'm watching with interest.

[GrayMatterWife]

Me, too, Julia! I am absolutely riveted. It is so exciting to hear the justices and "see" the way the think and reason. I am so glad that the Court is releasing the audios same day. I listened to yesterday's proceeding several times.

[Cinderella]

I didn't understand it when it was first happening and I don't really understand it now. I hope my work doesn't try to make me understand it because it seems like a behemoth to sort through.

I wonder though how it will affect the medical field upon the 2014 implementation. When I first heard about it I thought it was supposed to be implemented in stages and that has already started.

My personal feelings are that it's not right. This happen to me already when I was in college where they suddenly required all student to have medical insurance. Every semester another $700 went to medical insurance that I never used. That's a lot of money when you don't have much. One time I used it when I went to an Urgent care for an ear infection and my insurance wouldn't cover it. I felt that this mostly benefited insurance companies and stinks to high heaven. I didn't like it when it happened in college, and nobody organized to fight it. This was in one of the most conservative States in the union. This new health care law feels like what happened to us in college except there happens to be some people actually organized to fight it.

[oceanchild]

My personal feelings are that it's not right. This happen to me already when I was in college where they suddenly required all student to have medical insurance. Every semester another $700 went to medical insurance that I never used. That's a lot of money when you don't have much. One time I used it when I went to an Urgent care for an ear infection and my insurance wouldn't cover it. I felt that this mostly benefited insurance companies and stinks to high heaven. I didn't like it when it happened in college, and nobody organized to fight it. This was in one of the most conservative States in the union. This new health care law feels like what happened to us in college except there happens to be some people actually organized to fight it.

Ok, so let's play devil's advocate. Let's say your college didn't require you to have insurance, and you chose not to get it because it was expensive. Then let's say you're walking across a street on campus, and a car comes speeding through and plows you down. Ambulance, ER, hospital stay, maybe even surgery. Maybe you (or your parents) are actually wealthy enough to pay for that care, but what if you're not? Should the ambulance not come? Should you not be admitted? Should the hospital just treat you and drop all the charges?

[HouseofWool]

I think it is all a really interesting question. A while ago I heard Rush Limbaugh say that he was really pissed about the individual mandate. He doesn't want to buy insurance and can afford any treatment that is needed. Should he be forced to do so? I will admit that it was hard to argue his logic (I can't believe I agreed with the man!).

Healthcare needs to be affordable to the masses and it currently isn't, even to some WITH insurance. Personally, I don't have a problem with the mandate as long as there is an affordable insurance available. Whether that is people buying into the medicaid programs or some other option, I don't know.

[SoonerTexan]

I hate this issue. It is so complicated and convoluted with a million different facets--I don't really feel like I can form an educated opinion on the topic without devoting a couple months of my life to researching it. Yet it will affect us on a personal and professional level for a long time. I'm just doing the *Hold hands over ears lalalalala* until it is all over and we'll deal with the fallout when it is settled. Hope it doesn't suck too much.

[ladymoreta]

Here's my not very well thought out opinion, because I just want to contribute...

If we don't require everyone to pay into the healthcare system (through insurance or through taxes), we shouldn't require hospitals to treat patients who can't pay. We can't expect them to operate as successful businesses if they are forced to work for free.

[scrub-jay]

ST- I'd say more than a couple of months, most of my MPH classes have covered different facets of this reform. It is very very complex. One question at the core is this: should healthcare be a human right or should healthcare be a privilege in true capitalistic form? Oceanchild is spot on in her point to emergency care. Due to EMTALA (Emergency Medical Treatment and Medical Labor Act of 1986), emergency rooms treat you whether or not you are able to pay. This follows the idea that emergency care is a universal right (logically, what if you HAD insurance, but were in a car accident and your proof of insurance wasn't recovered?) but preventative care is not. The problem with this of course, is that the emergency rooms are flooded with individuals who have no insurance and are unable to pay for care. Conditions that could have been managed by primary care docs inexpensively become emergent and very expensive. To LM's point - the hospitals often end up eating much of the cost of the emergency room care provided to the uninsured or they bill the insured individuals more to recoup the costs. This, in turn, increases the costs of overall insurance premiums. Countries with universal health care systems have decided that health care is a human right, the U.S. is still struggling with this idea because it does not fit well with the capitalistic system that is so prevalent in the U.S. and reflected in the "American Dream."

[SoonerTexan]

I guess my very shallow view of it all is I am willing to pay the extra taxes/premiums if it truly means better access to health care for those that really need it BUT I'm not sure if the current plan is the way to do it or what the "correct" way really would be.

So *lalalala*

[scrub-jay]

I guess my very shallow view of it all is I am willing to pay the extra taxes/premiums if it truly means better access to health care for those that really need it BUT I'm not sure if the current plan is the way to do it or what the "correct" way really would be.

So *lalalala*

You know, there are parts of the law that I think are fantastic, other parts I find ridiculous and some items that are blatantly missing. If you are curious, a great start for information is healthcare.gov. It includes the actual law, but also outlines the changes by implementation date (I think it is called "Timeline of Changes")

[Cinderella]

Ok, so let's play devil's advocate. Let's say your college didn't require you to have insurance, and you chose not to get it because it was expensive. Then let's say you're walking across a street on campus, and a car comes speeding through and plows you down. Ambulance, ER, hospital stay, maybe even surgery. Maybe you (or your parents) are actually wealthy enough to pay for that care, but what if you're not? Should the ambulance not come? Should you not be admitted? Should the hospital just treat you and drop all the charges?

I'm not really interested in delivering more of my personal opinions on a hypothetical situation.

However, here are my thoughts on what I know about that. After working in a catholic hospital for many years I've seen what happens in these kinds of situations and I know there are several options. First, our hospital saw everyone that came to them. I don't know if other hospitals turned people away but ours was a not-for-profit. Our main competitor was also a catholic hospital and saw everyone. I have no other for profit hospital in our region to compare the not-for-profits with. Typically a social worker for the hospital would come work with the family and the patient to apply for medicare or medicaid. There are also various additional programs that provide additional assistance that they could apply with. These programs act like grants or scholarships where they pay for some, most or all of the expenses incurred. Sometimes such as in chronic cases a hospital will write off a portion of the bills. Then in the most dire of circumstances there is always medical bankruptcy.

[Vanquisher]

Hospitals aren't the only ones who eat the costs for those who aren't insured or who are underinsured. Docs do too, and in a BIG way.

I think the whole mess is all the fault of insurance companies. They are horrible corporations that make money, and a lot of it, by denying necessary medical care left and right, forcing doctors to write off thousands of dollars and people to lose everything.

I hate them all.