This morning or, possibly, Thursday the Supreme Court is expected to render its decision in the cases against the Patient Protection and Affordable Care Act AKA “Obamacare”. The decision is likely to be long and convoluted, possibly with complete concurrence on some aspects of the case and narrow majorities on others. The most likely possibilities for the final decision would appear to be:
- The Court upholds the PPACA in its entirety.
- The Court strikes down the “individual mandate” but holds that severable from the remainder of the law.
- The Court strikes down Title 1 of the act, the portion dealing with private insurance, but upholds the balance of the law.
- The Court strikes down the PPACA in its entirety.
The question is not whether a hypothetical Court could uphold the PPACA but whether this Court is likely to support the expansion of Congress’s powers under the Commerce Clause that the PPACA represents. I suspect that the answer to that question is “No” but I honestly have no idea on how the Court will rule. If I had to make a WAG, I would predict alternatives 2, 3, 4, or 1, in that order.
When Congress initially enacted the PPACA I was as mad as a wet hen. I thought that it was a byzantine, tortured half measure. It arranged to cover a few more people who presently don’t have insurance without covering everybody and do so in a way that was vague, maximized uncertainty, and maximized the bureaucracy that would be required to administer it. It only pretended to address the most pressing problem of our healthcare system (increasing costs) in order to grant insurance coverage to a relatively small additional number of people. Additionally, it assumed that Congress would tinker with the law in continuing approximation, fixing the unworkable or contradictory parts of the law, repeatedly, an assumption that flies in the face of the history of healthcare reform in the United States.
One aspect of this whole sorry mess that I do not believe has been adequately discussed: it highlights the problems inherent in prolonged incumbency. The members of the Congress have had the same arguments with the same people over such a long period of time that the discussion has solidified behind slogans. For the progressive caucus that comprised the Congressional leadership at the time the PPACA was passed the slogans were “guaranteed issue” and “community rating”. They had persuaded themselves that those two things would solve the problems with our healthcare system. Ironically, their implementation surrenders the fiction that healthcare insurance is insurance at all.
To satisfy that Congressional leadership guaranteed issue and community rating were the sine quae non. Everything else was persiflage.
The present Republican Congressional leadership has its own slogans: “market-based” and “health savings accounts” chief among them. The notion that those things can be implemented in such a way as to solve the problems we actually have is just as fictional as the progressives’ solution.
“The present Republican Congressional leadership has its own slogans: “market-based†and “health savings accounts†chief among them.”
I’d be interested in seeing arguments as to how a “market-based” approach would address this problem (rather than merely entrenching it further) Getting Lost in the Labyrinth of Medical Bills:
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The wife and I are going through a tussle with a hospital right now (arising out my ankle surgery last winter). It turns out that the hospital owes us money because we overpaid it upfront (we paid the amount they asked of us). We wouldn’t have found out about it save for the fact that we were having a fight with the insurance company which billed us for some services, even though, at the behest of the hospital, we had paid an amount exceeding our yearly cap. The insurance company claimed we hadn’t paid the yearly cap, but it was able to see that we’d overpaid the hospital. (The hospital copped to it after a long talk with my wife on the phone.) On top of this, the doctor is billing us now, too, for an amount almost identical to the overpayment to the hospital. Thank God my wife, who worked in the medical/hospital environment for years, knows how to navigate through this bullshit. For folks less sophisticated about these things, it must be a nightmare.
I think you’ve been arguing for some time that the idea that there is a “market for health care” is a chimera. There is no effing market.
Twice faced with a similar problem, I demanded a list of procedures performed by CPT code, then ordered the Medicare Allowance list of payments by CPT code (I had to file a FOIA to get it!). Then I offered to pay what the Medicare Allowance came to, since the hospital emergency room accepted Medicare assignment.
Radiography and the lab complied, and I paid them, and they accepted. The hospital would not provide the CPTs and I haven’t ever paid them. They wrote off $1000 or so, two times.
If they overturn the ACA I will make more money and/or work fewer hours. If it is not overturned, my group will lower health insurance premiums, my son will not lose his insurance when through with college and if a big corporation buys out our hospital and I lose my job, I will be able to buy insurance with our pre-existing issues.
Steve
The only way there can be an actual market in health care is if prices are known up front and can be compared.
Here’s one operation that posts its prices on the Web:
http://surgerycenterok.com/