Well, I was wrong. The Supreme Court has voted 5-4 to uphold the PPACA:
June 28, 2012 (WASHINGTON) — The Supreme Court has upheld the individual insurance requirement at the heart of President Barack Obama’s health care overhaul.
The court on Thursday handed Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.
The entire ACA is upheld, with the exception that the federal government’s power to terminate states’ Medicaid funds is narrowly read.
The White House must be very pleased. Relieved.
What I expect going forward is that, barring its repeal by a future Congress, the workings of the ACA will be allowed to play out. The law will not be expanded for the foreseeable future. A few more people but not everybody will have healthcare coverage. Due to the Medicaid portion of the decision the additional number covered will not be as many as projected. Healthcare costs will continue to rise at a rate sufficient for healthcare to remain the primary driver in the increasing cost of living.
Interesting decision. They rejected the commerce clause justification, so they managed to save the mandate without setting a new commerce clause precedent.
Presumably, Romney will now run against the Obama healthcare tax. And point out that he broke his promise against raising taxes on the middle class.
No doubt he’ll do that.
So, the administration denied it was a tax; the statute describes it as a penalty not a tax. Roberts rules that it was not a “tax” as that term is used in the Anti-Injunction Act, so the Court has authority to rule. But the penalty is actually a “tax” for purposes of Congressional power to tax and spend.
I think I follow the logic, but what do these types of machinations mean for public debate? When is a tax, a tax?
I’m a bit surprised as well. I expected them to nullify the mandate but leave the rest of the law more or less in place.
Maybe Justice Roberts took a moment to consider that we are the only nation in the western world that will bankrupt a sick person and leave him to die in a homeless shelter.
As many people raised many objections to ObamaCare my position was that this mattered because it established two things: Everyone’s in the pool, and Americans have a right to health care. Starting from that established responsibility and that established right I imagine the system will be adjusted in many different ways over the next decade or so. The responsibility and the right will remain intact. That’s what was do-able in the face of Republican intransigence and hypocrisy, and it’s a damned good thing.
Michael,
I think Roberts was more worried about the credibility of the court. The “right” to healthcare is an aspirational view, not a constitutional one.
I was wrong as well, in thinking the mandate would definitely be thrown out. The rest of the bill’s fate was uncertain.
However, Roberts really thought out of the box, by casting the mandate as a tax, thereby circumventing other issues of the bill, and making the severability clause (something I mused over considerably) irrelevant.
I am disappointed. But, on reflection, one positive outcome is that there will be no cries on the left of an ‘activist’ court at work in discarding this law. And, there will be far fewer cries, from the right, about said ‘activist’ court — mostly there will be surprise at Roberts being the one joining the majority in upholding the ACA, rather than Kennedy.
Some adverse reactions from this ruling, IMO, will be a dulling of business enthusiasm/job creation for the remainder of the year. There will be intensified partisanship, especially dealing with the impact of this now constitutional, arm-twisting health care bill that remains unpopular with the majority of people. Obama will be viewed as even more deceptive, as he adamantly represented the mandate as “not a tax.” Now we all know that the only way it survived Constitutional scrutiny was to be defined and honestly labeled as a tax. Finally, the tea party will have a resurgence, motivating an enthusiasm to vote that will be equal to or greater than 2010.
On the up-side, the commerce clause was not expanded by the Robert’s decision, and basically the bottom line to his reasoning is that it is not SCOTUS’s job to determine the wisdom of a law, but how it fits into the constitutional framework of this country…or not. Consequently, he has, with judicial restraint, thrown healthcare right back at the electorate to determine if they like the politicians and leadership who created this law. If they do, then Obama will stand to be reelected. If they don’t, he will be defeated, as will many of his democratic colleagues in both the House and Senate.
IMO, there is much more clarity of choice to the election of 2012, as of today.
I think Roberts was more worried about the credibility of the court.
Andy, just caught your statement, and I totally concur. Roberts may be considered a conservative turncoat, by some, for a while. However, I do think he was looking at the far reaching effects of this decision, and how it would impact the people’s trust in the court’s ability to have a non-partisan way at viewing and ruling on constitutional issues.
By some of Robert’s own language I don’t think he thought much of the law itself. But, he left the decision of how citizens wanted to be governed up to the them, by who they ultimately chose as their leaders in the election process.
I suspect this will not get much traction politically. The right will foam at the mouth but I suspect it will be like DADT repeal – everyone yelling until it finally happens, then they’ll discover it doesn’t have legs as an issue.
The right has only Mitt Romney to work with and of course every time he opens his mouth he’ll be reminded that he passed ObamaCare before it was ObamaCare.
Then there’s Mr. Justice Roberts – my hero – a Bush-appointed conservative. Justice Roberts as agent of the apocalypse? Really? Mitt Romney versus Roberts? I’m not seeing that working too well.
So good luck bringing the crazy with the human weathervane and the poster boy for conservative jurisprudence. Limbaugh and Fox will preach to the choir, but I don’t think the swing voters will be moved. I think they’re on to different concerns and this issue is last week’s dinner special.
I have a hard time seeing this making much difference to businesses. Large businesses already insure almost everyone. Small businesses should save money. I will. Good thing as I need to hire some more.
Steve
This shouldn’t be a surprise. Roberts was appointed by a man with a maximalist view of federal power in general and Presidential power in particular. The surprise is that Alito didn’t vote in favor of Obamacare too. The Bush family must be furious about Alito being a turncoat like that.
So now the federal government has the authority to make citizens buy whatever it wants them to buy. The President has the authority to assasinate any American anywhere without any restraint. And there is no real opposition to any of this.
We owe an apology, very belated, to George III.
It will only save money for small businesses that already sponsor healthcare for their employees:
or, said another way, it will cost the majority of small businesses money.
Don’t businesses generally consider costs in comparison to their competitors? So now responsible businesses won’t be at a disadvantage relative to less responsible businesses.
Any thoughts on this?
This could actually be seen as a little-“c” conservative decision. It rejected expansion of commerce clause power. It limited the authority of the federal government to blackmail the states with Medicaire.
Overall, I see this as a tactical victory for progressives and supporters of the ACA, but it could be strategically costly to them in the long term. It seems to me this ruling could be used as a basis to reject further attempts to regulate new areas under the commerce clause and to coerce states to adopt policies they don’t like.
sam:
I would be oh so very happy if Mitt Romney said this:
Michael – yes and no. For businesses of the same size, yes this does level the playing field for firms that were already providing decent health insurance. But it also disadvantages smaller firms in relation to larger ones, who are more able to offer benefits in the first place.
That said, for entirely selfish reasons I’m glad the law is living on another day. I’m one of those people who has a strong inclination towards business ownership, but has put it off because I can’t afford to be without healthcare coverage for even a short time. If the PPACA lives until 2014, it will make it easier for me to start up the company I’m planning.
(Yes, I’m aware that should I be successful, it will also increase my headaches later on. So I don’t blame current business owners for being pissed).
I thought Robert’s decision, whether you agree with it or not, was well-written and analytical. The only point of criticism is why he found it necessary to rule that it violated the Commerce Clause; its arguably irrelevant dictum.
Robert’s explanation is that the law is not written as a tax, but as a regulation, and only after finding that it would be an invalid regulation, did he feel it necessary to decide whether it could be a tax.
The alternative explanation is in line with something Orin Kerr predicted — that the mandate would be upheld within a framework of pronouncements that drew the line at this point, and no further may Congress go. Congress can’t make anybody eat broccoli or buy a G.M. car; it can make the tax code as inefficient as possible, so long as such behavior-encouraging taxes are not too high, they are performed through a comprehensive tax system, and the enforcement mechanisms are traditional.
I’m neither a conservative nor a libertarian so I’m not a good source. However, I’ll weigh in. There are only a handful of alternatives. Either as a society we accept the idea of differing grades of healthcare based on ability to pay (we have that now but we don’t admit it), we sacrifice private property, or we sacrifice involuntary servitude (in the form of physicians being unable to say “no” to a level of compensation they deem inadequate and what treatments will be provided to whom), or we try to strike some administrative balance among those. That is not an ideological position. It is merely physics.
Congress can’t make anybody eat broccoli or buy a G.M. car; it can make the tax code as inefficient as possible, so long as such behavior-encouraging taxes are not too high, they are performed through a comprehensive tax system, and the enforcement mechanisms are traditional.
Do you really think that the federal government, finding that they CAN do this to make people buy heathcare insurance (or risk death by sepsis as the IRS reams you non-stop) they won’t stop at making people do other things they want done? Do you really think they won’t make it mandatory to exercise (for our own good, of course) or pay
penaltiestaxes to the government? Why not make it mandatory that every home-owner put solar panels on their houses or paypenaltiestaxes to the government? Look at the benefits from the perspective of someone like Obama – he can now insure the the companies of his donors that he is already funneling government $$$$ to will now have a guaranteed customer base.You can’t tell me that the federal government isn’t willing to make the tax system even more byzantine, because they do that all the time anyway. You can’t tell me they aren’t willing to intrude into our lives to an ever greater degree, as they insist on doing that all the time anyway.
This is no limit on the government at all. This is mere sophistry (a specialty of the governing class and lawyers in particular) in order to get what they want – bigger, more powerful government.
Sam, I am certain that under the new scheme Congress and the President and the wealthy and the connected will continue to get more and/or better healthcare than the rest of us. Believing otherwise is laughable.
Then there’s Mr. Justice Roberts – my hero – a Bush-appointed conservative. Justice Roberts as agent of the apocalypse? Really? Mitt Romney versus Roberts? I’m not seeing that working too well.
Michael, You tend to go into over the top comments regarding issues. There are many conservative blogs who are throwing more dismay and surprise at Robert’s opinion, but not aspersions, like you would certainly be doing should he have voted in another direction.
As for Romney, did he even mention Robert’s name in his comments this morning? There is no agent for apocalypse in this decision. That’s just more theatrical rhetoric from you. There will be no Romney versus Roberts, either. The devil will be in the details of a bill which many have yet read, and many more find incomprehensible after they have muddled through it.
The pros and cons of this bill will be what is discussed; the winners and losers, the latter many are saying will be the poor and middle income populace because of the pending ramifications of the medicaid ruling in this bill. Also, there are more questions than answers, and more discontent in the court of public opinion, something which has endured over the entire time period since it’s passage in late 2009.
Furthermore, genuine concerns are what abound, not frothing at the mouth. Some doctors are predicting a two-tier system of healthcare will emerge should this law not be repealed — one for the average patient and another for a wealthier, private pay, like they have in the UK. The increased paperwork labyrinth, that most assuredly will be married to this HC system, worries other doctors about cutting into their patient time, because they are so busy trying to satisfy the sometimes insatiable bureaucratic regulations. Still others are saying, within our current climate of doctor shortages, even more physicians in private practice will exercise early retirement in order to avoid all the frustrating hoops this bill will demand of them.
How will this increase access for anyone?
My husband gave a more succinct answer as to what he sees happening:
A lot of doctors will migrate into the “I quit” status. Fewer people will become doctors. And, there will be longer patient lines for those doctors who remain.
@icepick, I think taxes are very unpopular; I doubt Obamacare would have passed if it was openly understood to be a tax increase.
Ezra Klein makes some of the same points I made in my comment above:
@icepick, I think taxes are very unpopular; I doubt Obamacare would have passed if it was openly understood to be a tax increase.
That’s why sophistry, and a fellating prostrate media, are so critical to the cause. Obama had to lie, his lieutenants had to lie, Congress had to lie, the media had to lie, sycophantic supporters of the President like Reynolds had to lie for their beloved leader, everyone had to lie to get this to work, until finally the court couldn’t quite do it anymore. I’m sure it will be much easier for the Roberts Court to just go with the flow on future rulings. These things get easier with practice.
Fuck it, the Constitution is just used toilet paper now.
Jan, your husband is wrong. This now puts doctors and high-end medical bureaucrats in the same status as bankers – they are now part of the ultimate renter class, and the government will see the nation burn before it allows these people to fail. After all, it is for the good of the country that doctors get to increase their rates at several times the rate of inflation every year.
We will see government subsidies to bring in more bureaucrats to help the doctors with their paperwork (with higher proces for the customers of course). That will insure that we have even more people on the government payroll, directly or indirectly, which will mean the need for even more taxes (or alternatives just as bad), more power for every lick-spittle pol that gets elected, more power for government unions, more power for lobbyests, more power for lawyers (SOMEONE will have to wade through all those regulations), and less money and power for everyone else.
And for all of this some people will get marginally better healthcare than they get now.
Mission accomplished.
Icepick,
Politicians lied to get a bill passed? I’m sorry, but that is so unremarkable it’s hard for me to get outraged. People have complained about lying politicians for centuries.
Lying about a bill implies knowledge about the bill’s contents. It’s a step up as far as I’m concerned.
Ah, the old slippery slope. If government can draft 18 year-olds what’s to stop it drafting three year-olds and 90 year-olds? If government can outlaw the word “fuck” on broadcast media what’s to stop it outlawing the word “liberty?” If government can tax your income what’s to stop it taking your blood? Etcetera and etcetera.
Every single action any of us takes — individual, corporation, government — can be cast as the start of a slippery slope. This morning I ate raisin bran, which is just one step on the slippery slope to eating the dog. I drove to San Rafael at an average speed above the legal limit, just the first step on the slippery slope to driving to Canada at 200 mph.
The reason slippery slopes only slip about .00001% of the time is that we are not suddenly deprived of the faculty of reason. Engineering type folks and libertarians love to reduce the world to mechanical systems – if the wheel is out of balance it will eventually fall off. But humans are not machines and our institutions are not mechanical. They are human institutions and therefore do not follow predictable paths.
So no, doing now what every single other free and prosperous nation on the face of the earth has long since done, is not a step on the road to tyranny. (As evidenced by the fact that whatever France, the UK, Italy, Germany and so on may be, they aren’t tyrannies.) It’s just a step on the road to ensuring that getting sick doesn’t mean you die broke. That’s it.
Icepick
I don’t agree with you about doctors faring well under this act. To be in a private practice (unless it is strickly a private pay one), it will be too regulated and frustrating for many to want to manage. Many doctors will simply default to being on staff in a hospital environment. But, the pay is set, and the work schedule, especially for surgeons, can be grueling. Many hospitals are also tenative about hiring full time staff doctors, in their efforts to avoid paying benefits. This leaves some physicians (I know one well) who is on permanent part time status, at several hospitals, in order to meet her bills.
Slate has come out with an interesting take on this decision, in saying: Obama wins the battle, Roberts wins the war.
@Michael Reynolds
The reason slippery slopes only slip about .00001% of the time is that we are not suddenly deprived of the faculty of reason. …
In the past you have argued that we cannot use the past as a guide for the future. If I recall correctly, it could be different this time. Oh wait, it is different this time because it is the Great and Wonderful Michael Reynolds making the pronouncement.
“Then the bowsprit got mixed with the rudder sometimes.”
“Do you really think that the federal government, finding that they CAN do this to make people buy heathcare insurance (or risk death by sepsis as the IRS reams you non-stop) they won’t stop at making people do other things they want done? ”
Yes I do. The states already have the power to pass a broccoli mandate. They never have. I trust the power of the voter and democracy more than 9 politicians in black robes. The interpretation of the law can change. There simply wont be any broccoli law passed.
Steve
Tasty:
I can pretty much guarantee that I’ve never said anything that broadly simplistic. Have I argued that we don’t know the sun will come up in the east just because it always has? Yeah, I don’t think so.
But I appreciate that you find me both great and wonderful. I’ll be sure to quote that in the future.
See? It’s kind of annoying when someone takes you out of context, isn’t it?
Andy, I’m more annoyed by the Holier-than-Thou left in this country that keeps insisting how saintly and pure they are. (Reynolds above is instructive. He makes it clear that he doesn’t care what the Constitution says, only that Roberts should rule in a way that will make him look good to other leftists around the world. He gets to be seen as caring compassionate so-and-so while living in Marin County, where they could not be more clear how much they hate those that aren’t rich like them. Poor people are grand, as long as they’re someplace else.)
Think CNN, CBS, NBC or ABC will call Obama for being such a blatant liar on this front? The NYT? The Washington Post? No. But the next time some Republican dog catcher in Butt Fuck Flyoverstan gets some minor detail wrong it will be the crime of the century. No mention of this will come up except on Fox News, and only there because that’s how they make their nut.
mostly I am sick of just how blatant this was, and how much the Obama worshippers just eat this stuff up. It’s not as bad as a Nobel Peace Prize for a sociopathic killer who brags about it in the press, but it’s still pretty bad.
Lying about a bill implies knowledge about the bill’s contents. It’s a step up as far as I’m concerned.
They knew enough to know about the central funding pillar. That part wasn’t exactly hidden, unlike say the 1099 crappola.
Jan:
Our doctors are the best-paid in the world. So they’re going to quit to. . . do what, exactly? Wait tables?
@jan- Where do you get these ideas? Sigh. First, most docs are already hospital employees. It is actually hard to get new docs to even consider non-employed, private practice like what I did. They all want to be in a group, and most want the more regular hours of an employed doc. Hell, I cannot even get any of the younger docs interested in taking my position.
Next, what new regulations are going to make things more frustrating. I will assume you are sincere and maybe I dont know. Can you link to them? The only things I can think of are EMRs (only an idiot does not realize we need to move to them), using cost effectiveness research (we should anyway) and ACOs? ACOs are a pilot program, so they will not necessarily become universal, and some administrators were already wanting to continue them assuming, as most did, that the ACA was overturned. Long term, most people involved in health care economics know that costs have to come down. So, I really dont see docs going Galt. (This has always made me laugh. Like what is a 50 y/o doc really going to do?)
Steve
don’t agree with you about doctors faring well under this act. To be in a private practice (unless it is strickly a private pay one), it will be too regulated and frustrating for many to want to manage. Many doctors will simply default to being on staff in a hospital environment. But, the pay is set, and the work schedule, especially for surgeons, can be grueling. Many hospitals are also tenative about hiring full time staff doctors, in their efforts to avoid paying benefits. This leaves some physicians (I know one well) who is on permanent part time status, at several hospitals, in order to meet her bills.
jan, once the doctors start complaining, the government will step in to “fix” the problem. They’ve been going to cut Medicare payments for how many years now? I think it’s fourteen years running now, and every year, even though they can’t pass a budget otherwise, they come up with the money to NOT institute the planned cuts to Medicare. Because it would HURT THE DOCTORS! Ohs noes! We can’t have that.
This will be more of the same, especially as it will play to every politician’s ego and need to create more for themselves to do. (And create more opportunities to skim off the top.)
Do you really really think the government WILL NOT want to expand their reach even more? They’ve done that under Republicans and Democrats alike. They’ve done it under unified governments and split governments. They’ll keep doing it now, because they now have the chance to “save” the medical system, again and again, ad nauseum ad infinitum. This will be a bigger scam than the federal highway system and the defense budget put together. And if it isn’t already, it will be after a few more years of medical inflation.
I predict the first thing they’ll do will be to forgive student loans to an ever expanding set of doctors. First those that go into poor, underserved areas, then those in needed specialities, and so on. Eventually, it will be necessary to forgive the student loans of plastic surgeons in LA because otherwise Hollywood won’t have enough plastic looking people to populate the thousands of shows and movies produced each year.
Just for the record we do have poor people in Marin County. But not in Tiburon, unless they’re here cleaning homes. Yes, I confess: I live in an enclave of wealthy old white folks. It might as well be a gated community. The cops photograph everyone who drives into town.
How this relates to my desire to help poor and working class people afford medical care, I don’t quite get. I don’t recall ever saying I loved poor/working people. I’m pretty sure I’ve never said anything about loving anyone outside of my very immediate family.
TastyBits, it works like this. Whenevere history suggests that Reynolds position is wrong, it is different this time. Whenever history suggest Reynolds is correct, history is the ONLY guide to the future.
Got it?
@Dave- 1) You forget the tax benefits.
2) Most/may really small businesses are all family. They actually want insurance, but cannot afford it.
3) IIRC, businesses under 50 are excluded from having to buy insurance, but cant take advantage of the credits and the exchanges.
Steve
“Presumably, Romney will now run against the Obama healthcare tax. And point out that he broke his promise against raising taxes on the middle class.”
As well he should.
But on to some thoughts on the ruling.
A couple years ago I actually sent to Dave a thought piece on the whole health care issue. It was authored by a former partner of mine and me. To call it a position paper would be a bridge too far, but because writing crystallizes thinking this was a practice we engaged in frequently.
One of the points we made, after some titanic debate, concerned mandated insurance. The argument went something like this: 1) despite sometimes juvenile commentary here, or in Congress, or in the media, we are fundamentally a caring and sympathetic society; we allocate tremendous resources to government 2) therefore, people arent going to get turned away, and it creates the so-called free rider problem, in which the costs will be borne by someone who freeloads..so what to do?, 3) perhaps a mandate is required, but what about the implications?
I have made the same point here and at OTB any number of times. It flummoxes me.
I think the first interesting point of the ruling is truth in labeling. The court ruled in favor as this was deemed a tax. Otherwise, it was gone. It was never advertised as a tax. It was absolutely denied as a tax. Liars. Its a tax, it was always a tax. Obama was a tax denier. I think he’s going to have to come clean. He knew it; we knew it, everyone knew it. A man must be held accountable; President Obama, your brief for a ginormous tax increase?
Second, we now have to ask what the implications are as a tax. I have two points. First, I know people routinely discount my fundamental point, which I’ve made repeatedly: small business owners have been frozen into inaction on expansion and employment, waiting for this decision. The decision went the wrong way. It will have implications. Second, from a philosophical point of view, I think about this somewhat like the minimum wage. If it is increased, those of certain pursuations tell us all about how they have helped the average schlub. Those unemployed as a result, have no voice.
There is a bunch of back slapping about how the Average Joe has now been served by Obamacare. But there is no voice, because its invisible, for those now who are, or will become, unemployed. There is a real tradeoff if you can get past high school arguments (See: Michael Reynolds), and deal with real economic and business tradeoffs.
Its easy to to say “hooray for ourside,” its a bitch to reconcile the tradeoffs.
As I said, I’m flummoxed by the free rider issue, but Obamacare will be a complete and total economic and quality of care disaster.
Just for the record we do have poor people in Marin County. But not in Tiburon, unless they’re here cleaning homes. Yes, I confess: I live in an enclave of wealthy old white folks. It might as well be a gated community. The cops photograph everyone who drives into town.
yeah, and you were so fucking worried about civil rights six years ago that you shit your pants whenever anyone even said the word “bush”. now you seek out places to keep the riff-raff in check to protect your precious rich ass.
So typical it’s not even funny.
we allocate tremendous resources to government
Yes, and after a few trillion spent on the War on Poverty, how has that turned out?
funneling all that money through government has been a big help, to the government. The poor? Not so much.
Ice:
Not to interject annoying reality or anything, but: before Tiburon I lived in an actual gated community in Irvine. Before that a villa in Tuscany. And before that two laughably bland and upscale developments in the white, liberal enclave of Chapel Hill. And before that a Victorian in Evanston, IL. So it’s been riff-raff free for a long time now. And before that, Minneapolis.
Then again, before that it was garden apartments and third floor walk-ups in Sarasota and Maitland and Ocean City and Johnson City and Richmond and Portland, Maine. A house on Cape Cod. (But since we were cleaning toilets at that point I don’t think we can talk elitism.)
Prior to that it was base housing and trailer parks in Newport News and Niceville and more.
So, yes: as I got richer I lived around fewer poor people. Call me crazy.
The point is, you have made a point of insulating yourself from them as much as possible. (Except for the servants, of course.) It was not always thus that the rich people completely segregated themselves away although some always have. Also, I note that the more sequestered the rich get, the more they want to pass massive social programs to make themselves feel like they actually care. The result of that is that the middle class gets taxed more, because there just aren’t enough rich people to pay for it all. And the result of THAT is more stratification, a smaller middle class, more poor people, et cetera.
But hey, you get to congratulate yourself on how wonderful you are, and that is the important thing. If any of these programs worked, the War on Poverty would have been over decades ago. Instead … well, how have all of those public housing units worked out? Why will this program work any better than that?
@Jan, and @Drew
Both parties used and withdrew the “tax” term as needed. When drafting the bill the Republicans called it a tax. They stopped calling it a tax when it wouldn’t have helped their case before the court. Now that it’s no longer before the court they are back to calling it a tax.
To me it has never been any different than raising taxes on everyone and giving a deduction for having health insurance. In other words, a tax. Only those that got caught up in the mandate rhetoric could think otherwise.
@Dave
What are if not “small c” conservative? Seems to me like you’d be right at home in the Canadian Conservative party, anyway.
I think that it’s mathematically impossible for Romney to get the rates he wants, along with the revenue he’s said he’d raise without eliminating tax breaks for the middle class. Were I Obama I’d counter with that.
Steve,
I get my ‘ideas’ from talking to other people, those in medicine and those who are served by it. Somehow if a person is equipped with alphabet soup commentary, such as exhorting the merits of ACO , EMR or lets go for the whole 9 yards and lump it all together in the all-inclusive HCIT. Now, isn’t that clear to everyone here!
My experience with doctors is that many prefer private practices to being in a swarm of doctors as a staff member. It’s safer, but, to some, far less rewarding. However, like all private enterprises, or self employment businesses, it is getting more difficult by the day to live and function without more and more infusion of government intrusion, whether government entities know what they are talking about or not. Sans tort reform being addressed, malpractice insurance has gone through the roof. Then there are the problems and deficits with government medicare/medicaid payments. Without the annual Doc Fix, there would be more physicians on the short end of payments or opting out of medicare, altogether. Consequently, the increasing bureaucracy, and all the paperwork associated with it, overwhelms the warm/fuzzy feelings that many doctors used to receive via a more personalized type of patient care. It’s now become more a profession of serial doctors checking the right boxes, looking at their watches and going home, making way for another doctor to come in and check the appropriate items.
Like you said Accountable Care Organizations (ACO) are still being formulated. You can download white papers on them. Yes, Electronic Medical Records (EMR), like books on kindle, are the way of the future. But, I have never really felt they are a secure way to transfer medically sensitive data, especially from the eyes of big brother. But, I’m sure you don’t care about that, because HIPAA compliance covers that, another government vaccine meant to insure portability and privacy leaks.
And, where are the savings going to be generated for health care costs? By all this new efficiency? Doctors who are opposed to the ACA say that such savings do not come from 3rd party payers, who are never aware of costs in the first place. In fact this lack of consumer knowledge is one of the fundamental problems for high health costs in the first place. Similar to the housing bubble, the education bubble, when you get something for little down or free, most people don’t worry about costs or abusing the service, until it is too late, or the money runs out.
As far as doctors leaving the profession, there were very high numbers being thrown around at the inception of PPACA — something like 45%. I doubt this will materialize to such a high percentage. But, there are doctors, in their 50’s, who, although still interested in medicine, may resort to leaving and living on other investments or working on other life interests. Waiting on tables? I doubt that. But, taking up a pottery wheel? Maybe. People do eventually reach a threshold, and then they just walk away.
I would never deny that. I’m scared of ever being poor again. I’m not being cute, this is literally what I worry about at 4 AM, along with my wife or kids dying. I didn’t like poverty, and I don’t want to do it again.
As for the efficacy of war-on-poverty programs I think SS has worked pretty damned well, if by worked you mean moved giant piles of money out of the pockets of the young and working and into the pockets of the old and increasingly wealthy. We sure don’t get a lot of stories about old people eating dog food anymore. And this bothers me because I am literally surrounded by trust fund alter kockers with yachts who are collecting SS and Medicare. I’d like to help working people, not my neighbors.
I think (but it’s an assumption only) that food stamps probably reduced rates of malnutrition. Poverty-related programs like subsidized immunization work well – not a lot of typhoid going around. But I don’t know how well they work in general.
Tell you what, Jan, I’ll give a dollar to your favorite charity for every doctor who can be shown to have actually quit the profession solely because of the ACA. Ain’t gonna happen. It’s silliness.
“Tell you what, Jan, I’ll give a dollar to your favorite charity for every doctor who can be shown to have actually quit the profession solely because of the ACA. Ain’t gonna happen. It’s silliness.”
Talk about silliness. How is one to prove that? But if you go out and actually speak with them, or potential doctors, you know that this has consequences.
I’m sure you deny the effects on business as well.
You know I’m genreally a fan, Michael, no matter philosophical differences, but the stream of your comments has been some of the most putrid and cheap rot I’ve ever seen. You are in denial, and I’m somewhat embarrassed for you.
.
“I get my ‘ideas’ from talking to other people, those in medicine and those who are served by it. ”
If that is your only source, you will come to the wrong conclusions. Most doctors think they have nothing to do with increasing medical costs. Most are ignorant about health care policy.
“My experience with doctors is that many prefer private practices to being in a swarm of doctors as a staff member.”
I would counter your personal experience with the actual numbers. Physicians are mostly employed. This happened well before the ACA. It has been years since I talked with a medical student who wanted to go into individual private practice.
“Without the annual Doc Fix, there would be more physicians on the short end of payments or opting out of medicare, altogether. ”
This is something that all conservatives need to decide upon. If you want to keep Medicare payments up, you need to figure out how to reduce costs at the same time. You cannot have it both ways, unless you have some plan I dont know about.
“Consequently, the increasing bureaucracy, and all the paperwork associated with it, overwhelms the warm/fuzzy feelings that many doctors used to receive via a more personalized type of patient care. ”
This went away with DRGs. Just so you know, the paperwork from the private insurers is also bad. In my profession, it is actually worse. I pay a person just to handle credentialing for all of the private insurers, which we have to redo every one to two years. Not so for Medicare or Medicaid. It is much more efficient and less hassle for them.
” Doctors who are opposed to the ACA say that such savings do not come from 3rd party payers, who are never aware of costs in the first place. ”
Show me how you make it work w/o insurance. Seriously. Remember the demographics of health care spending. If you dont know them, I can provide the links. That said, there is an element of truth to this, but I dont see a great way around it. Probably the best is to have everyone in the same system. Every other nation in the world with quality care has people in the same general system. If costs go up it affects everyone. They are motivated to reduce or control them.
“But, I have never really felt they are a secure way to transfer medically sensitive data, especially from the eyes of big brother. ”
You do realize the main reason we need so much privacy is because we do not have universal insurance. I am recruiting again. It would be a real bonus if I knew the medical history of those I am interviewing. For a small corporation like mine, it would really help to keep costs down.
“As far as doctors leaving the profession, there were very high numbers being thrown around at the inception of PPACA — something like 45%.”
By those who opposed it. I work at 6 different medical facilities now. I know of no one who has left because of the ACA. I dont know anyone who knows anyone who left. You should mostly think of this as people saying they will leave the country if candidate X is elected. (I actually wish that the people who say that would leave. Serve them right.)
So, I am still interested if you have any information other than word of mouth about how new regulations are going to force docs out of practice. I, like most docs, think I am over-regulated, but I have not seen a sudden spate of new regulations. The most onerous ones are often state regulations. A lot of the ones that keep costs up are perpetuated by my own Society. Just because I dont know about these new ones coming on line does not meant they dont exist. Maybe I missed them, but would like to see what they actually are rather than the generalized complaining of professionals who are not any better informed than the general public.
Steve
What sort of reforms would have been your preference, steve?
Well, I’m not a progressive. And I’m not a conservative as the term is used today in the United States which approximates what we used to call a Southern Democrat.
Centrist. Non-ideological. Pragmatist.
I’d probably fit okay with the Tories or with the French or German center-right.
You wouldn’t know it from the blogosphere or from the Congressional Democratic leadership but less than half of the present Democratic Party is liberal or progressive.
Isn’t this the physician’s survey that was being discussed recently?
http://www.forbes.com/sites/susanadams/2012/04/27/why-do-so-many-doctors-regret-their-job-choice/
I must also confess I don’t understand how this is supposed to fix the free-rider problem. Will my neighbors, with one low-wage no-benefits job supporting two adults and three children, not be free-riders now? They can’t afford insurance on their own. So presumably they will be subsidized? How is that much different from the current situation. On this front all this does is change the mechanism of how the free-riders get their bus fair as best I can tell.
Most of the free-riders are people that just can’t afford the insurance, period. It’s not like there are a lot of people like Drew and Michael out there that don’t insure themselves but then throw themselves on the mercy of emergency rooms and THEN refuse to pay their bills.
From the article PD Shaw just linked to:
IOW, doctors want the government to make their lives easier.
I’ve also wondered about the effectiveness of using income tax returns for a mandate; half of all people don’t pay income taxes, will they fill out the return, or assume that such paperwork doesn’t apply to them?
Also from the article:
So in order to increase efficiency the government wants to add another layer of bureaucrats. Hmmm. Drew, is that how you PE guys do it?
I’ve also wondered about the effectiveness of using income tax returns for a mandate; half of all people don’t pay income taxes, will they fill out the return, or assume that such paperwork doesn’t apply to them?
Yeah, but even if you don’t pay, if you’ve got income you fill out the forms. And most people are claimed on someone’s form or another.
I suspect that TurboTax is behind this whole damned scheme.
steve, “IIRC, businesses under 50 are excluded from having to buy insurance, but cant take advantage of the credits and the exchanges.”
With the possible addition of an additional limit on $ income per year to be considered a small business, that’s my recollection as well. But weren’t the exchanges to be set up by the states, and are they going to do that now?
icepick, I think Medicaid expansion was supposed to pick up those who couldn’t afford coverage, and the mandate was supposed to pick up the group of young adults who could afford it, but decided to take their chances. These groups may have converged in the intervening years.
Drew:
Aw. Sour grapes. Sad. But don’t worry, your candidate, the Human Weathervane will be along any minute now with his alternative plan. Oh, wait, sorry: I just checked and he already had a plan which he put into effect in Massachusetts. Which was totally not different than the one he’s condemning today.
So, just to recap Mr. Olympic Business Genius and all-around Drew avatar, Mitt Romney, created a plan identical to the one he’s now condemning, and he’s your candidate, and you’re stuck with him, and you’re sorry for me. Well, that’s generous of you.
I’ve been avoiding this because we’re talking intelligently about a serious matter, but just for you, Drew: We won, you lost, and we won with Mr. Chief Justice John Freakin’ Roberts. John Roberts just validated RomneyCare. Er, ObamaCare.
RobamaCare? ObomneyCare?
So nyah. Also, nyah. And a final, nyah.
I would totally dance but I think dancing is unmanly.
Actually if private health insurers were as efficient as Medicare we’d be saving money. Of course they have to divert a lot of their resources into finding excuses for dropping coverage for sick children. But now, hey, maybe they can fire those folks and actually achieve levels of efficiency seen in our socialized Medicare system.
Drew:
Dancing anyway. Kind of a Zorba thing, I like to think. Where’s my retsina?
drew, you must be one of the two or three conservatives and/or libertarians they keep mentioning as being longtime supporters of a mandate. I know many Republicans, and they never mention this particular longing. Tax simplificatin; regulatory reform; cloning Ronald Reagan, they can’t stop talking about that last one.
Da da da da dadada, hey!
Da da da da dadada, hey!
And now, ladies and gentlemen, let’s segue from Zorba to Tevye.
Yubby dibby dibby dibby dibby dibby dibby dum.
Mogen David, baby!
Okay, that’s not true, I can’t drink Mogen David.
These groups may have converged in the intervening years.
You should have had an UNDERSTATEMENT ALERT before that sentence.
Drew, Michael is right on this point: His side won, your side lost, and you’re stuck with Mitt Fucking Romney, the Human Weathervane. Really think he’s going to repeal this, even if he magically has the votes in the Senate?
You got no chance in Hell….
PS I thought Mormons didn’t wear flip-flops, but we’re already getting the big flip-flop walk-back from Romney on illegal immigration. Not that anyone is surprised. I don’t think we will ever see a major party candidate get nominated for President that doesn’t want to import a few hundred million third world peasants into the country. It’s one of those things the ruling classes in both parties agree upon, the need to elect a new populace.
Anecdotal from another blog site. No way to prove or disprove it, however, just putting it out there:
Fact or fiction, I don’t know. But, I’m sure eventually there will be some interesting stats to indicate what if any effect Obamacare is having on doctors staying or withdrawing from the profession.
Ice:
I don’t think they’ll even try to repeal. It will get down to specifics: we’re throwing your loser 23 year-old son off your medical insurance; we’re raising prices on grandpa’s Viagra; etc…
Nah, this is over. It’s just noise at this point.
Now, whether it’s all a good idea or not? I’ll reiterate my point – fairly consistently iterated — that my goal was to see medical care established as a right and as a responsibility. Mission accomplished. I make no claims that this cuts costs, saves the world, or buys us tickets to the Batman movie.
“Will my neighbors, with one low-wage no-benefits job supporting two adults and three children, not be free-riders now? They can’t afford insurance on their own. So presumably they will be subsidized?”
Kevin Drum has some back of the envelope calculations on this. Worth a look.
@Michael
“Actually if private health insurers were as efficient as Medicare we’d be saving money”
Speaking of which. You’ll know, right, about the 80-20 rule now in effect? Insurers to Refund Consumers $1.1 Billion.
The docs who appear to be unhappiest are the PCPs. That is largely a function of their lower salaries.
I come at physician complaining about salaries from a different perspective, partially explained by Dave every now and then. As an E-2 many years ago, taking home about $100 a paycheck, I remember the civilian docs who worked with complaining about their salaries. They were driving Cadillacs, living in spiffy houses and eating at nice places. I drove a beat up Gremlin (God, it hurts now to admit that) and lived in a two bedroom apartment with 4 other guys in South Philly. Couldnt figure out what they were complaining about.
Now, I still listen to guys complain. The ones who complain the most are often the ones with the Porsches, the million dollar homes and spiffy wives (the second trophy wife types). I still cant figure out why they complain so much. They always want to compare what they make with some sports figure, or a $400/hour lawyer or an investment banker. It is just not a valid comparison.
Steve
Sam:
I just heard about that today. Of course I’ll be stunned if a check actually shows up. I’m not psychologically prepared for that.
I make no claims that this cuts costs, saves the world, or buys us tickets to the Batman movie.
If it doesn’t cut costs, you’ve just insured that the whole country is going to go belly up sooner rather than later. Nice job!
God, it hurts now to admit that
It must have hurt then to live it.
Ice:
Might go belly up, but I’m willing to bet not before a Batman reboot. Five years from the last Raimi Spiderman to the new Sony/Columbia Spiderman, so I’m thinking we have three, maybe four years.
Sam, thanks for the Kevin Drum link. Here’s a bit about a family of four:
But here’s the thing: If there is no way for the government to collect the fine then it is still cheaper to for them to not buy a policy. And for families on the margins like this they’re going to have to seriously consider not buying policies in any event.
Plus, and this gets back to my earlier point, they are still free-riders. Only the mechanism gets changed, not the actuality.
I’m still working on the premise (stated long ago somewhere in this blog’s comment section) that the whole thing has been designed specifically with the intent of completely wrecking the current medical delivery system and probably the economy with it. After all, we know Obama doesn’t like to waste a crisis, and how big will the one be whent he entire medical system grinds to a halt and the federal government with it?
Dodge Dart we bought for IIRC $300, after-market paint job in robin’s egg blue. The rear fenders were both rusted out so I couldn’t get it past inspection. We’re living in Ocean City MD at this point, I’m waiting tables and Katherine is delivering flowers. Probably 1987, give or take, so I’m 33.
So one cold night I come home from an off-season shift, do the whole fiberglass cloth and Bondo thing, but it’s too cold to set. So I run white drier hose from the heater back through where the speakers should be, into the trunk. Then I pass out in the car with the engine running, hoping to cure the Bondo. Cops suddenly appear, skid to a halt — the neighbors called it in as a suicide.
Now that was a piece of shit car. People used to stop dead in their tracks and point at that thing.
the neighbors called it in as a suicide.
Owning a car like that, can you blame them?
“Well, we knew they were having financial troubles, and why else would he buy a car like that? It’s only good for the exhaust fumes….”
I thought the same thing at the time. I think I made $40 in tips that night and was living in this place where the heat was so weak we had to abandon all but the bedroom. We had plastic sheeting all over the windows and used to sleep fully-dressed. Good times.
Great, now I’m depressed remembering it.
Great, now I’m depressed remembering it.
Good, I’m redistributing the pain.
Here are some other random articles/thoughts on today’s rulings:
Steven Haywood writes on the Robert’s rules of disorder.
As did Jay Cost of the Weekly Standard: What did the SCOTUS just do?
As a non-sequitur postscript: IMO, a pattern of Obama’s, these past 3 1/2 years has been an attitude of dividing groups in order to gain an upper hand with one while demeaning the other. Not in any particular order, he has proceeded to divide groups by race, religion, classes, wealth, and even states, many doing battle with their own federal government (the 26 states suing over the ACA and AZ and immigration).
There is usually a bad guy and good guy in Obama’s scenario; an “I won” and “you los”t kind of unsavory rhetoric. This is from a man who originally saw no red or blue states, but rather a united states. This was a black/white candidate (A zebra, as Chris Rock referred to him as), who was going to be a bridge rather than a moat between races. This was a guy who promised to cut deficits in half and yet doubled them. He practically guaranteed lower employment (below 8%) by passing his stimulus. Instead, what his policies produced was a stagnated economy where business has often felt as if it were being held hostage by obtuse government regulations and unfriendliness.
With all of the above one would think he could easily be defeated. But, Obama has also doubled the food stamp program, has been growing the welfare state, not addressed our troublesome entitlement programs — basically bribing a good segment of the population to simply stick with him and he will look out for them. And, this tact may very well work for him.
Justice Roberts does not strike me as a churning urn of burning funk, and I’d suppose he is a right Catholic, so it wouldn’t surprise me to find out that he is following doctrine. He doesn’t like the way health care looks in the US, and he cares to work toward a more equitable solution.
My husband’s always told me that the the Supreme Court is behind society about ten years
I don’t think they’ll even try to repeal.
Oh, they’ll make a show of it, because it will play well to the base – good for fund-raising for the 2014 cycle. But they won’t make a real effort, or pull out all the stops. They won’t pull an Obama and simply refuse to enforce the law, either, although I understand some Republican governors are making that noise now. We’ll see how far that goes….
@Michael Reynolds
I can pretty much guarantee that I’ve never said anything that broadly simplistic. Have I argued that we don’t know the sun will come up in the east just because it always has? Yeah, I don’t think so.
You may not have meant it to be broadly simplistic, but you did say it. In addition, I would not consider the context to be broadly simplistic. To help you, the context was future innovation. Unlike @Icepick, I am not going to search thousands of threads to find your exact quotes.
… Ain’t gonna happen. …
At it again are you? Or, is this statement also broadly simplistic?
But I appreciate that you find me both great and wonderful. I’ll be sure to quote that in the future.
See? It’s kind of annoying when someone takes you out of context, isn’t it?
Context: White = Great, Rich = Wonderful
I fail to understand how I took you out of context, but if you provide specifics, I will re-evaluate my observation.
NOTE: I specifically add ellipses to alert the reader that the quote is only snippet from a longer construct, and I may have taken the original quote out of context. If I were intentionally taking you (or anybody) out of context, I would not bother.
Micheal
That was pathetic. Its a serious issue, not an SEC football game, where you get bragging rights. Real people are going to lose employment opportunity. This is the real deal. You should be ashamed of yourself.
Icepick
Same. Somehow these internet debates become sport. You are out on your ass. Reality is, these policies matter. This does not improve your chances. Good luck, unemployed dude, but stop bitching and whining if thats your stance. You make your bed.
I’m back to Led Zep III now……………….
“All I need is all your love…………”
@Michael Reynolds
… Yes, I confess: I live in an enclave of wealthy old white folks …
[…]
How this relates to my desire to help poor and working class people afford medical care, I don’t quite get. …
The problem is that you have isolated yourself from the consequences of the solutions you support. Your concern for the “poor and working class people” is only for your benefit. The devastation your solutions have caused is not your problem.
How many Section 8 housing is in your area? Are there any projects? Do the businesses have concertina wire atop the fences? Is there a MLK Blvd? Do your children pass through a metal detector to get into school?
For the typical rich white liberal, the answer is no, and I expect your answer is no different.
Have you ever lived around Section 8 housing? Have you ever lived in or around a housing project? Have the businesses How many crack whores have you passed going home? Have you ever lived anywhere owning a gun was not an option?
For the typical rich white liberal, the answer is no, and I expect your answer is no different.
For shits and grins, why don’t you take a trip to MLK Blvd in Oakland or LA? (For some reason, it is always in the darker parts of town.) You can expound on your compassion for the poor, black, brown, etc. how you are working to improve their lives. Explain how you understand their plight. (I am sure you have read Dickens.) Make sure you are condescending and paternal. Do not forget to ensure the ones with a lower IQ of your concern for them. I am sure they will be happy to know that the Great and Wonderful Michael Reynolds is doing all he can for them.
How about attending one of Minister Farrakhan’s speeches, and you could explain to the Nation of Islam that you are working to better their lives. I am sure that will go over real well, but I think you will fare better there than the streets. If you would like, I will be happy to accompany you to either.
Truthfully, I really cannot tell the rich white liberals from the neo-Natzi, but the rich white liberals have accomplished what the neo-Natzis have only dreamed.
Poor folks, black folks, brown folks, young folks, working folks, and any other folks you want to “help” do not need you to be their savior. They are capable human beings, and if you would get out of their way, they would do a lot better. You should adjust your attitude. You are no better than anyone.
@Icepick
Drew, Michael is right on this point: His side won, your side lost …
Actually, both sides won. As you pointed out, he Republicans will not repeal it. They will bitch and moan, but in the end, it is a money maker for them and their friends.
You are saving me a lot of time with your comments. I am in agreement with almost all you have written.
@Michael Reynolds
The actual winners are Democrat and Republican politicians, lobbyists, pharmaceutical companies, insurance companies, hospitals, and others. The only ones making any noise were the Republicans, and this will bring in donations for years to come.
The only right that was won is for the above to screw the middle class. Poor and lower income folks will not be financially burdened. Rich folks will not be financially burdened. But, “middle class” folks will be required to foot the bill for all. Rich liberals will whine that are not taxed enough, but the will take every tax loophole they can. (If you take the standard deduction, you will be paying your fair share, but I am not holding my breath.)
@Icepick
The point is, you have made a point of insulating yourself from them as much as possible. …
I wonder how fast he would put out the for sale sign if he had section 8 moving next door or how welcoming he would be if his son or daughter brought home a hoodie rat or thug?
“Obama has slapped the single biggest tax on the middle class in history, after promising not to do that.”
Bigger than FICA? Income tax? I think not. It will only affect those w/o insurance who choose to go w/o insurance coverage. That is ok with me.
“How many Section 8 housing is in your area? Are there any projects? Do the businesses have concertina wire atop the fences? Is there a MLK Blvd? Do your children pass through a metal detector to get into school?
For the typical rich white liberal, the answer is no, and I expect your answer is no different.”
Rich white conservatives (pardon the redundancy) live in those neighborhoods? (Most wealthy are actually conservative, at least by their donation pattern.)
“With all of the above one would think he could easily be defeated.”
Perhaps because your perceptions are wrong. Step away from the echo chamber. He really is not much different than your guy. He is just another politician, better in some ways and worse than others.
“This is from a man who originally saw no red or blue states, but rather a united states. ”
I suspect a record number of filibusters opened his eyes. There may not be red states, but there sure are red Senators. Given that the pattern has been to escalate, if Romney wins, it should be interesting. My bet is on the GOP suspending the filibuster if they sweep, but if not, expect retaliation.
Steve
Its a serious issue, not an SEC football game, where you get bragging rights.
Clearly someone who doesn’t understand SEC football.
…
As for your other statement, yes, this does have real consequences to me. But what difference does that make? Reynolds’ assessment is correct, his side won. Your side lost. And the best you can do for a candidate to oppose this is the guy that created the baseline plan for it in the first place. Do you really think Romney, McConnell and Boehner are going to have to balls to shut this down even if they do get the votes? No chance in hell, especially since Romney is in favor of it. (Spare me the crap that he says he isn’t. When he had the chance to do something meaningful, THIS is what he choose to do. And Romney has shown that no words that come out of his mouth have any meaning. The only reason he gets away with it is because the R voters are desperate, and Romney is exceptional in his brazenness.)
Also, spare me the crap that I support this, asshole. I just think the opposition of you Republicans is meaningless, and that you all know it is meaningless. If you guys stood on prinicple you wouldn’t have the leaders you have. You guys are as much against the constitution and against the bulk of the country and Michael and his crew. You are just looking to rape and loot the country for a different group of thieves.
…
TB wrote, “Actually, both sides won. As you pointed out, he Republicans will not repeal it. They will bitch and moan, but in the end, it is a money maker for them and their friends.”
Yeah, later it occurred to me that this will be an even bigger money maker for both sides that anything else. Rs can run on repeal from now to the end of time, Ds will always have the threat of it being repealed. This is MUCH better than SS or MC, because this won’t just affect old people, and because Rs can raise funds off it too. Endlessly divided government, with fantasitc fund raising and back room double-dealings, for all. Only the people will lose, and those suckers deserve it so that the rich, powerful and connected can live the high life.
You people are missing the big picture: We’re all going to die and everything we acquire or accomplish will turn to dust and be forgotten.
So in acknowlegment of the total uselessness of anything that will ever be done in our lives, can’t we all agree this subject is one of the many not worth giving a damn about, and just go surf? Can’t we get along?
@steve
I hope that you are not including me in the remainder of your comments. You only quoted me once, and I will address that one.
My position is close to @Icepick’s. I still believe in innovation, and this will not be the end of the US. It will be a drag on the economy, but nobody knows how much. My guess is something similar to the minimum wage drag combined with regulatory impediments, but it is just a guess.
Rich white conservatives (pardon the redundancy) live in those neighborhoods? (Most wealthy are actually conservative, at least by their donation pattern.)
Rich white liberals have no respect for the people they want to help. In reality, the only people they want to help is themselves by inflating their ego. Many of the problems they want to address are easily fixable. More taxes – take the standard deduction. White privilege – leave your safe white community. Global warming – move to a smaller house. Public transportation – get a bus pass. Suburban sprawl – move to the inner city.
I only throw in the “white” to tweak them.
I have problems with rich conservatives. I get tired of hearing about “pulling oneself by one’s bootstraps”. It is not easy moving on from one’s surroundings. The people who are able to do it are an example for everybody, but everybody cannot do it. Not everybody is a “winner”. and we cannot all be above average. If it were easy, I would expect to see the “middle class” shrinking and the “upper class” increasing. I have never heard “middle class” folks included in the bootstrap pulling.
I omit the “white” because it is applicable to all colors who have improved their circumstances. (I did not get the chance to unload on @Drew for his comments in the last few weeks. I am not in agreement with @Icepick’s comments.)
The people that the liberals want to help, and the people that the conservatives want to help themselves are not infants or imbeciles.
FYI: The young and healthy free riders should be split into the ones who can afford health insurance and those who cannot. Newsflash – if you are young, you probably cannot afford health insurance, and with the new “lowered” prices, I am sure they will be able to afford it – NOT.
[Intentionally Blank]
@Icepick
I should have included the race hustlers and poverty pimps to the list of beneficiaries.
Most people do not get it, but not because they are stupid or “sheep”. Most people do not understand how a hustler (player, insider, operator, power broker, etc.) thinks. Me – I figure we are all hustling. Some are better at it than others. Find the hustle, and follow the money. It starts to make sense at that point.