OK, so the ACA is now Constitutional, despite the insistence of Rand Paul that it is not because, well, he doesn’t like it;
“Just because a couple people on the Supreme Court declare something to be ‘constitutional’ does not make it so.
Rand Paul (R-Zorack)
The whole thing remains unconstitutional. While the court may have erroneously come to the conclusion that the law is allowable, it certainly does nothing to make this mandate or government takeover of our health care right,” Sen. Paul said.
“Obamacare is wrong for Americans. It will destroy our health care system. This now means we fight every hour, every day until November to elect a new President and a new Senate to repeal Obamacare,” he continued.
Oh Christ, let’s not spend too much time on this bubblehead, but it is a touch disconcerting to see an actual US Senator display that level of stupidity about the role of the Supreme Court.
Rand, brother —”Just a couple of people” decided, in exactly the same way, that money and speech are synonymous and that corporations are people so far as the Bill of Rights is concerned. We feel your pain. Deal with it, you little shit.
Anyway, in the end, the only person I know of on the whole internet to predict both the outcome and the Constitutional principle upon which that outcome would be based, is our intrepid Bluthner.
I thought that the argument for the ACA which appealed to the Commerce Clause would be struck down, as it in fact was, for reasons that have been hashed over so much there’s surely no need to go over it all again. I simply did not understand the “tax and spend” argument which Bluthner advanced, and ultimately Chief Bottlewasher Roberts applied, to uphold the law.
So there it is. Basically, as I understand it, the entire framework of the ACA is now approved with the single exception that, in the event an individual State decides not to expand Medicare as dictated by the ACA, that State may not be “punished” by having Medicare funding for existing programs withheld. This essentially renders the Medicaid expansion mechanism optional on the part of each State, since the “penalty” for noncompliance is removed.
This last is odd, and we’ll be hearing more about it in the future without a doubt. I remember back when the Feds decided years ago, during an oil “shortage”, to mandate a 55 MPH speed limit from coast to coast, even on State Highways. This was accomplished by the threat of withholding Federal highway funding for noncompliance. Presumably now, with this new “anti-coercion” principle enshrined in the ACA decision, such schemes would be disallowed, and the effect that this principle may have on all sorts of programs which involve State/Federal participation could be profound. Certainly there’s ammunition there for a whole new round of legal challenges to programs for which there is strong ideological opposition.
Anyway, we are where we are, and this is now what we’ve got in terms of trying to deal with the US health care crisis. And it is a crisis, despite what various cheerleaders for market wisdom have to say. There are going to be no further substantive changes for a good long time, so the task is to do the best we can with what we’ve got.
If I was in charge of the White House PR campaign now, I would advocate a Full Court Press to actually explain what the ACA does and does not do. If any single thing is clear from the polls it’s that people don’t really have correct ideas about what the ACA actually is. This is no accident of course—there has been a very expensive campaign from the right to produce exactly that result, and in their usual bungling fashion the democrats have failed miserably to counter it.
Given that Willard is running (so he says today, anyway) on a policy of repealing ACA, more oceans money will now be sluiced into muddying the waters, and it would be smart to get out in front of that, and fast. I remain convinced that most of the “opposition” to the ACA is rooted not in a dislike for the real provisions so much as a manufactured ideological boogeyman. Time to fix that.
There are in fact enough positive provisions in this Act to make it perfectly palatable to most Americans if its proponents can break through the noise. I wish I could express confidence that they will, but that’s not the kind of thing they’re very good at, judging by earlier form.
Interesting – dental is the one type of care that i actually need right now. Uncovered, of course, by the ACA. Oh well.
I had a Canadian friend living here (with pre-existing conditions too) who couldn’t believe we had no universal health insurance and wondered how we could stand for it. I just said that i don’t know, i never had it so i was in no position to miss it. (She went back home to Ca. finally to do research for a university and get her coverage.)
……and a couple of beleaguered conservatives of course
yikes.
From the mid-1980s to 2005, California’s population grew by 10 million, while Medicaid recipients soared by seven million; tax filers paying income taxes rose by just 150,000; and the prison population swelled by 115,000.
California’s economy, which used to outperform the rest of the country, now substantially underperforms. The unemployment rate, at 10.9%, is higher than every other state except Nevada and Rhode Island. With 12% of America’s population, California has one third of the nation’s welfare recipients.
http://online.wsj.com/article/SB10001424052702304537904577277242682364690.html
yes, i’m still considering moving to California in the near future.
Like everywhere else overall healthcare costs will continue to rise because of increased demand and a continually improving product however we should see improved average outcomes and better value for money. Funding battles will become the norm – just like in the UK.
Amy, as someone who just moved from California back to the east coast, I just don’t get the appeal. Then again, I was in LA and hate driving.
On the plus side, there’s a lot of radio in LA.
Jabs -
I pretty much hated LA, lived there 3 1/2 years. Bay Area for me.
I’ve heard Bay Area is nice, but I must admit that I’ve never been
I’m an east coaster. LA was weird, there wasn’t really a city there. SF is a proper city, and Berkeley is a nice granola munching burb. Good public transpo. Absolutely loved the weather there too. There is an outdoor life in the Bay Area that doesn’t exist in NYC.
Bay Area weather is, of course, close to perfect. I spent most of my childhood and youth in cold, wet climes, so I love sunshine but really have a tough time with heat and humidity. I was in Virginia and Georgia earlier this month. Interesting to visit and lots of nice people, but too hot for me. Plus it’s strange not to be able to see very far when driving; the trees along the roads are so dense. I’m used to be able to see miles in all directions; it can be a shade jarring to only be able to see straight ahead and perhaps 50 feet to the side.
Vermont also has the Health Care is a Human Right movement. Wonderfully earnest and well meaning folks that I have met at several meetings.
However I wonder – as with many other positive rights – how much and of what standard of healthcare is a human right?
There is no right answer but everyone will want the maximum possible in an ongoing contest for limited resources. After all it is a human right – how could anyone condone anything less?
It will be a never ending battle. Even if we spent all of our resources on health care we will all die in the end. Don’t expect to be singing Kumbaya any time soon.
No, not everyone. Not everyone is as greedy, either for resources or perfect health, or longevity, as you imagine. Some of us are quite willing to live with less than the maximum, and conserve whether we are paying for it or not. Some of us actually take the needs of others into consideration.
You probably do Madam – and God bless you
But I bet that the arguments and debates over NHS funding will pale into insignificance in comparison. Not necessarily a bad thing but inevitable when it comes to allocating scarce resources.
Good thread here.
Can’t be bothered to comment on Randy, but I will say, yet again, that I love LA. I think my aversion to the Bay Area is very idiosyncratic and historical: have spent a lot of time there, in places that are not so desirable, and even when I am in the nicer spots, I just can’t seem to shake certain times and places.
Okay, well…I felt no indignation when the SC and Roberts ruled on the ACA. Far more cranked about Kelo and various law-enforcement rulings.
This from the NYT tonight. Looks like i wasn’t terribly far off in my skepticism about states accepting the Medicaid funding.
http://www.nytimes.com/2012/06/30/us/politics/some-states-reluctant-over-medicaid-expansion.html
Since we’re all fans of the marvelous David Brooks here, it’s time to listen up and take heed because he’s finally consented to explain it all:
Which Matthew Yglesias disrespectfully compresses: “In other words, Brooks wants to repeal Obamacare and replace it with . . . Obamacare. Or rather with a more vigorously implemented version of Obamacare.”
If young Matthew thinks he can replace Brooks in our hearts simply by, you know, figuring out what he’s saying and then putting it into words, he has another thing coming. For instance, who but Brooks could have slipped in that edgy contrast between “liberals” and “Republicans?” That one came as a revelation to me, no doubt because of my parochially narrow view of things, based as it is solely on observation and anecdotal data – in this case, from the suggestive but (I now see) misleading absence of fund-raising pleas from Liberals Against The Public Option. To which I now realize I must contribute, just as soon as I can find their mailing address.
“Vermont also has the Health Care is a Human Right movement.”
Once in a very rare while RI does something right. We now have the first Homeless Bill of Rights in the nation, and are actually getting past the bullshit walks bit and doing something about it. They have a program now to get apartments for the homeless too, who do all they’re supposed to – show up at appointments, etc. One tiny step towards rolling back the damage done by St. Ronnie.
The Dems should right now go and make some commercials in which a pudgy white guy in kakis, white button down shirt and bad tie with American flag button pinned to his shirt pockets doorsteps is a down-home accent some dodgy-looking East Coast bohemians drinking coffee at leisure in the middle of an urban morning, and interviews them about their history with health insurance. The one with the soul patch admits, reluctantly, that he has been free-riding til now, but, to his chagrin, now that the SCOTUS has spoken, he really is going to have to forego a upgrading his laptop and actually do the responsible thing and buy some health insurance. Or pay the penalty, his bra-less girlfriend pipes up. He nods. That law has nailed me, bang to rights.
Clean-shaven pudgy white guy in button-down shirt and tie pumps his fist: yeah! Another Free-rider bites the dust!
Thanks to Obama….
From Jim Wright at Stonekettle:
Perhaps it would work in Islington Bluthner.
I think that you are going native
Bluthner, are you denigrating the bra-less? What did we ever do to deserve that?
Madame, please remain bra-less! The point of my commercial (despite the bang to rights, I cop a 26 years in London plea on that) is to trick the rageheads into admitting that getting some people they fear and loathe to end their free-riding is a good thing.
I did notice that you didn’t defend the soul-patch, though.
Bluthner, I might if I had any idea what a soul patch is.
Bluth,
Usually Jim Wright (the Stonekettle one) can do no wrong in my eyes. But if he thinks any significant bunch of conservatives still remembers why the Heritage Foundation came up with the individual mandate and who supported it at the time, then for once he’s fallen behind.
Start with Erick Erickson:
The “biggest tax increase in American history” line is of course lifted from Mitt himself, but he’s getting all the help he needs. Larry Kudlow at The National Review announces that John Roberts has “expanded [the] power of taxation that will bring us more mandates, more entitlements, and less personal freedom, all of which will further cripple the economy.” He has precise numbers: the non-partisan “Investor’s Business Daily says this comes to a $675 billion tax hike over the next decade.” But Erick isn’t surprised: “that’s what happens when you install European-style entitlements.”
But it’s the “less personal freedom” thing that really has them going.
Mike Pence, likely the next governor of Indiana, “likened the Supreme Court’s ruling upholding the Democratic health care law to the Sept. 11 terrorist attacks.” (He then apologized, having apparently been reminded that 9/11 must forever remain sacredly sui generis in the annals of perfidy.)
Anybody, track record or no, who thinks we’ll hear one word from these guys about what the law (or John Roberts, for that matter) actually says is just kidding themselves. Still, there may still be a smidgen of a silver lining here: I suspect that “the end of America as we know it” may prove to be a more fertile ground for speculation than brother Shapiro suspects — if anybody cared to take him up on it.
I have now been educated on the soul patch and want to be on record as NOT defending it. Yuck.
As long as we remain free to hyphenate “bra-less,” everything will be okay. Would it be wrong to tax the shit out of bigass German luxurycars and chainrestaurant burgersandfries to finance healthcare?
Bim,
How ’bout a tax on high fructose corn syrup about equivalent by weight to the current tax on tobacco?
Nat,
I think the more the rageheads talk that OTT shit about ‘the end of America as we know it’ the more crucial swing voters are going to not sit at their table.
They said the same thing when the income tax amendment was passed, when the voting rights acts were passed, when the schools were desegregated, and nine dozen other times as well. Hell they said it when they lost the fucking war of northern aggression in 1865, too, and, well… every time they said it they were somewhere right around 100% correct. The country did change.
Or shall we use a really dirty word and come right out and call a spade a spade and say the country evolved. Which is what all living systems do. That or die.
Rageheads as we know hate evolution. They prefer stasis and death. Sane swing voters, and there are a useful number of them out there, will choose life.
Bluth,
I suspect that Bim would prefer a tax on highfructosecornsyrup, but I probablyshouldlethersaysoherself.
I’m not particularly concerned about the death-of-liberty argument. I think that anybody susceptible to it is already thoroughly suscepted.
But I think the biggest-tax-increase-in-American-history line could have legs. Because the counterarguments all rely on facts, which is the weakest imaginable electoral strategy — always has been, always will be. Somewhat more than 80% of Americans have health insurance. Polls keep reporting that the majority of that 80+% are satisfied with it. But how many of them know that this law won’t require them to pay a penny more than they do now? I really doubt that very many of them do. I think that most of them think they’ll have to pay for freeloaders like Gunny and me.
Nat -
You’re a freeloader? Thought you had good coverage.
I would imagine that they’d freak out a lot more at the notion that ACA may cause their employer to drop them. (Nevermind that they may eventually get dropped anyway.)
I suppose i’m a freeloader, but i rather refuse to think of myself in that way. Seeing that i am indeed uninsured, but i still kick in via taxes for Medicaid, EMTALA, insurance for government workers, etc.
Oh, and Medicare too. Which i technically i guess shouldn’t count, because the folks that are eligible have already paid into it for their entire working lives. But should i croak before i’m eligible -a distinct possibility because i expect the age to rise a few times before then, and i could be half dead already for all i know – that would be money i paid in towards care for others as well.
Amy,
I most certainly am a freeloader, the very worst kind, in fact. I’ve been self-employed since 1975. For years I had very nice (tax deductible) coverage from Prudential. When I turned 50 they saw that the entire group of one had stepped into an undesirable actuarial pool and cancelled me. For about four years thereafter I had a shlock policy from some sort of bogus association of the self-employed. It started out at a few hundred a month and was up to a monthly $1800 when the company that issued the policy decided to go out of business (something I later learned they regularly do every few years). By then I was married to an irresponsible woman who had foolishly contracted a per-existing condition, so my insured days were well and truly over. By the time she died (uncovered) I had acquired some conditions of my own, along with a couple of deep grudges that continue to flair up from time to time even today, and which, for example, render me incapable of appreciating the subtlety of the argument that any healthcare law short of single payer is too deeply compromised to support.
Ah.
You can add my signature to the Granola Munching Freeloading Liberals Against Single Payer or Public Option too.
As a fellow self-employed, my income tends to be erratic, undependable, and uneven. So if i were to be responsible and purchase insurance, if i could afford the premium one month, there’s no guarantee at all i could make the payment the next month. Let alone should they decide to cut me off because i have blue eyes or i’m too short or something. No sense throwing good money after bad when i’d rather pay rent and have a roof.
I wonder how many of those with pre-existing conditions will be able to afford what the insurance companies will be allowed to charge for those policies. I can’t remember the percentage above a “normal” policy but it wasn’t chump change.
Or if there will be co-pays or deductables.
Gotta say:
I’ve kinda come around to the point where I see the ACA as a less noisome pile of shit than the pile of shit that is nothing. Always been supremely bugged by the payoffs and buyoffs and buyouts – to insurers, unions, pharmaceuticals, etc. – but i guess those are going to be an issue no matter what is done.
As I’ve mentioned, I have spectacular insurance through my employer, but that really doesn’t affect my opinion here. The last time I did not have insurance – some time ago – I got a piece of metal stuck in my eye (while doing a terrible job) and nearly let myself go blind because I couldn’t afford to see a doctor. Eventually somebody else paid to have the offending sliver removed. That’s the kind of crap that happens…
You guys are great, by the way. Cif might have outlived its usefulness.