OBAMA/TRUMPCARE MEGATHREAD

[NorthSideSox72]

That's not good, because the whole law won't work without the mandate.

Sort of. Requirements like no pre-existing conditions and no lifetime limits can stand just fine.

 

[Y2HH]

Sort of. Requirements like no pre-existing conditions and no lifetime limits can stand just fine.

 

Before I begin, do I think those changes were good...yes, very much so.

 

Now...that said, here is the problem they introduced. The system, as it is, will fall apart without the mandate because why would you pay for insurance you don't need? It would take people a while to catch on to this, but eventually they would. Since, under law, they cannot deny coverage due to pre-existing conditions...there is no need to buy insurance until you're on the way to the doctor/hospital. And it takes just minutes to sign up these days. System failure. It's the very reason they put the mandate / fine in there in the first place, to make sure the Insurance companies are covered from this type of behavior.

 

That's the crux of the pre-existing conditions issue and a large reason why it existed in the first place. That said, they openly and outwardly abused that pre-existing clause by just denying people that could be high risk, even when they shouldn't have...that wasn't the original intent of the rule, but of course, that's what it became...sadly.

Edited March 27, 2012 by Y2HH

[Y2HH]

Now, I do have a fix for this controversial issue, without the mandate.

 

You have open enrollment periods once a year, but you make them long enough and loud enough that people KNOW it's open enrollment time. There are exceptions to these rules, such as marriage, having a child, etc...where those persons can be added to your insurance outside of that window. HOWEVER, if you don't enroll during that enrollment period, you have to wait until next open enrollment and hope you don't get hurt/sick. Of course, there would be other caviots to this rule, but it would fix the "wait until you're hurt/sick and then buy insurance" gimmick.

[Soxbadger]

Or you just change the insurance policies, ie you have a $10k deductible for anything in the first month of treatment.

[Y2HH]

Or you just change the insurance policies, ie you have a $10k deductible for anything in the first month of treatment.

 

This is what I meant by other caviots...these types of things could work to deter people from trying to cheat the system...which they would do.

[NorthSideSox72]

Now, I do have a fix for this controversial issue, without the mandate.

 

You have open enrollment periods once a year, but you make them long enough and loud enough that people KNOW it's open enrollment time. There are exceptions to these rules, such as marriage, having a child, etc...where those persons can be added to your insurance outside of that window. HOWEVER, if you don't enroll during that enrollment period, you have to wait until next open enrollment and hope you don't get hurt/sick. Of course, there would be other caviots to this rule, but it would fix the "wait until you're hurt/sick and then buy insurance" gimmick.

I'd be down with that.

 

[Soxbadger]

Im not too worried about insurance companies, they are very good at making money.

[NorthSideSox72]

Im not too worried about insurance companies, they are very good at making money.

That's not even in question here. The question is, in the situation where only parts of this law stand without the mandate, HOW will they make their money and what effect does that have on people?

 

[Balta1701]

That's not even in question here. The question is, in the situation where only parts of this law stand without the mandate, HOW will they make their money and what effect does that have on people?

They're going to have to lobby heavily to have that provision removed. It will destroy their business and they know it. Which means Congress is going to have to take up allowing insurance companies to reject pre-existing conditions, or the court will have to strike down the whole law. And whatever complicated scenario they set up, I guarantee you I'm going to call it "bill to allow people with pre-existing conditions to die". Because it will be.

[NorthSideSox72]

They're going to have to lobby heavily to have that provision removed. It will destroy their business and they know it. Which means Congress is going to have to take up allowing insurance companies to reject pre-existing conditions, or the court will have to strike down the whole law. And whatever complicated scenario they set up, I guarantee you I'm going to call it "bill to allow people with pre-existing conditions to die". Because it will be.

Very possibly.

 

What they should do is scrap the garbage PPACA legislation and enact the NSS72 Health Plan I suggested in here when PPACA was being debated, but dammit, they just don't listen to me.

 

[Balta1701]

Very possibly.

 

What they should do is scrap the garbage PPACA legislation and enact the NSS72 Health Plan I suggested in here when PPACA was being debated, but dammit, they just don't listen to me.

I just want Medicare for everyone, but ditto.

[Y2HH]

Im not too worried about insurance companies, they are very good at making money.

 

No, they're actually not.

 

But because taking peoples word for it often results in repeating false information, here are some actual numbers from publicly traded for profit insurance companies.

 

Last Quarter, 2011

Humana : Net profit margin 2.20%, 3.85%

Aetna: Net profit margin 4.35%, 5.88%

Universal American: Net profit margin -3.52%, 0.01%

Wellpoint: Net profit margin 2.19%, 4.36%

UnitedHealth: Net profit margin 4.85% 5.05%

AmeriGroup: Net profit margin 1.99% 3.10%

HealthNet: Net profit margin 2.14% 0.61%

 

As you can see...profit margins in the health insurance industry are actually quite low and always have been. The BIGGEST companies may hit 5% on a VERY good year. They often hit 2-3%.

 

Now, for kicks, let's compare it to big pharma:

 

Pfizer: Net profit margin 8.92% 12.96%

Merck: Net profit margin 12.55% 13.30%

Eli Lilly: Net profit margin 14.19% 17.90%

Bristol Myers: Net profit margin 22.57% 24.76%

Glaxo Smith: Net profit margin 18.40% 19.93%

Roche: Net profit margin 20.54% 22.44%

 

Pharma makes, on average, 2-4+ TIMES the profit margins that insurance companies make.

Edited March 27, 2012 by Y2HH

[StrangeSox]

I just want Medicare for everyone, but ditto.

 

If this leads to our really, really dumb for-profit insurance system imploding and being replaced by socialized coverage, I'm down.

[Y2HH]

If this leads to our really, really dumb for-profit insurance system imploding and being replaced by socialized coverage, I'm down.

 

You realize that the government can't even afford medicare/medicaid right now, but you think they'll magically be able to afford socialized coverage? LOLz.

 

Be ready for income tax rates upwards of 50%, not to mention various other taxes, fees, and fines...which of course, you aren't EVER getting through congress at this point. Our entire tax system, from the local all the way to national, would need massive reform for that to EVER happen.

 

TL;DR, even if our system implodes...not happening. They'd sooner revert back to what it was before you ever see that kind of overall systemic reform happen.

[Balta1701]

If this leads to our really, really dumb for-profit insurance system imploding and being replaced by socialized coverage, I'm down.

it won't. We're not that lucky. This will lead to a whole lot more people being uninsured and a whole lot angrier of a crowd trying to defend their health care when they're the only ones left who have it.

[Y2HH]

it won't. We're not that lucky. This will lead to a whole lot more people being uninsured and a whole lot angrier of a crowd trying to defend their health care when they're the only ones left who have it.

 

Don't worry Balta, I'll get you covered.

[StrangeSox]

You realize that the government can't even afford medicare/medicaid right now, but you think they'll magically be able to afford socialized coverage? LOLz.

 

Be ready for income tax rates upwards of 50%, not to mention various other taxes, fees, and fines...which of course, you aren't EVER getting through congress at this point. Our entire tax system, from the local all the way to national, would need massive reform for that to EVER happen.

 

TL;DR, even if our system implodes...not happening. They'd sooner revert back to what it was before you ever see that kind of overall systemic reform happen.

 

We're stuck with our dumbest-in-the-advanced-world system forever, aren't we

[StrangeSox]

I'm reading that the arguments today pretty much ignored precedence.

 

Good thing we all hate activist judges.

 

edit: jesus christ Scalia actually brought up the "broccoli mandate" GOP talking point. I don't think I can view this court as having any real, objective legitimacy any more, regardless of the final ruling.

Edited March 27, 2012 by StrangeSox

[Balta1701]

Don't worry Balta, I'll get you covered.

Would have been nice if someone could have helped me out 5 years ago when I couldn't get my wife covered.

 

(Still couldn't if I wasn't part of an employer pool, so any thought I might ever have of starting a consulting company is cut off at the knees without the PPACA, btw).

[Y2HH]

I'm reading that the arguments today pretty much ignored precedence.

 

Good thing we all hate activist judges.

 

edit: jesus christ Scalia actually brought up the "broccoli mandate" GOP talking point. I don't think I can view this court as having any real, objective legitimacy any more, regardless of the final ruling.

 

Yea, I'm not a fan of that court...either side of it. Because there should be no "sides" on that panel. I dislike the fact that 4 are "liberals" and 5 are "conservatives". If you are either, you shouldn't be allowed on that bench. Period.

 

If at any point in your history as a lawyer or judge, you based a decision on any sort of liberal/democrat/republican/conservative idealism, you should never be allowed on the supreme court...and that can be shown about each and every one of them.

[StrangeSox]

Yea, I'm not a fan of that court...either side of it. Because there should be no "sides" on that panel. I dislike the fact that 4 are "liberals" and 5 are "conservatives". If you are either, you shouldn't be allowed on that bench. Period.

 

If at any point in your history as a lawyer or judge, you based a decision on any sort of liberal/democrat/republican/conservative idealism, you should never be allowed on the supreme court...and that can be shown about each and every one of them.

 

That's kinda silly, everyone has personal political and judicial philosophies that guide their decisions. That doesn't mean they are making rulings that they know aren't correct interpretations of the law but are being explicitly politically partisan. BTW that's why elected judges are such a dumb idea!

 

Some more great reasoning from Scalia:

 

When Justice Ruth Bader Ginsburg observed that “the people who don’t participate in this market are making it much more expensive for those that do,” Scalia interjected,“You could say that about buying a car. If people don’t buy a car, the price [that car buyers] will pay will be more.”

 

So much for making reasoned, legal arguments and not dumb polemics.

[Y2HH]

That's kinda silly, everyone has personal political and judicial philosophies that guide their decisions. That doesn't mean they are making rulings that they know aren't correct interpretations of the law but are being explicitly politically partisan. BTW that's why elected judges are such a dumb idea!

 

Some more great reasoning from Scalia:

 

 

 

So much for making reasoned, legal arguments and not dumb polemics.

 

It's not silly.

 

Yes, you can have personal philosophies...but they should NEVER be used to guide your decision. Their job is to interpret constitutional law, as written. Period. Their job is NOT to interpret said set of laws based on their ideals. The entire reason they say justice is blind...is that VERY reason.

 

And yes, this court is explicitly and politically partisan one side or the other. That's why nearly every vote is 5-4. The only time you see a vote go higher than that, either direction, is when the law is pretty damn clear. But right now, what's going on in there is PURE idealism...you have 4 "liberal" justices defending the health care law and 5 "conservatives" attacking it.

 

Seriously, what the f*** is that?

 

I don't think my opinion that the highest justices in the land should be completely representative of BLIND justice is silly at all.

[StrangeSox]

Interpretation of laws is guided by judicial philosophies, though. There isn't One True Interpretation. Some people believe in using legislative intent while others don't, so their jurisprudence will guide them to different rulings. That's different than ruling from political outcomes (cough Bush v Gore cough).

 

FWIW I don't think most cases are 5-4, just the big ones you hear about.

[StrangeSox]

You also have an overwhelming number of legal scholars who, until today, felt pretty sure that the SC would find that mandate clearly constitutional. So you can't fault the liberal justices for supporting what most constitutional scholars believed was the proper interpretation of the commerce and N&P clauses.

 

Kennedy's concern appears to be over the government defining a "limiting principle," but previous Commerce rulings required no such standard and, besides, limiting principles already exist in previous conservative rulings and aren't expanded by the ACA.

[Soxbadger]

No, they're actually not.

 

But because taking peoples word for it often results in repeating false information, here are some actual numbers from publicly traded for profit insurance companies.

 

Last Quarter, 2011

Humana : Net profit margin 2.20%, 3.85%

Aetna: Net profit margin 4.35%, 5.88%

Universal American: Net profit margin -3.52%, 0.01%

Wellpoint: Net profit margin 2.19%, 4.36%

UnitedHealth: Net profit margin 4.85% 5.05%

AmeriGroup: Net profit margin 1.99% 3.10%

HealthNet: Net profit margin 2.14% 0.61%

 

As you can see...profit margins in the health insurance industry are actually quite low and always have been. The BIGGEST companies may hit 5% on a VERY good year. They often hit 2-3%.

 

Now, for kicks, let's compare it to big pharma:

 

Pfizer: Net profit margin 8.92% 12.96%

Merck: Net profit margin 12.55% 13.30%

Eli Lilly: Net profit margin 14.19% 17.90%

Bristol Myers: Net profit margin 22.57% 24.76%

Glaxo Smith: Net profit margin 18.40% 19.93%

Roche: Net profit margin 20.54% 22.44%

 

Pharma makes, on average, 2-4+ TIMES the profit margins that insurance companies make.

 

I think you completely missed the point, I said "insurance companies" not just limited to medical insurance. That being said, they are still making a profit, which is not that common in today's economy. Insurance companies for the most part dont lose money, that is the point. Its not about how much profit they make, its about the fact they almost always make profit.