And there is still the argument that is wasn't passed as a tax so I am hoping, if it takes effect, some rich dude decides to not buy the insurance and then pursue the idea that the administration can create a tax without congressional authority all the way to the top. You know, someone like Bill Gates or everyone's favorite lunatic fringe republican business man, Donald Trump. Because then how would the SC approach it. That part (making it a tax) was not voted on by Congress and one justice (at the urging behind the scenes of the Administration) made it into a tax. Judicial activism if ever there was such a thing (I don't believe the Constitution grants the right to create a tax to the Judicial or Executive branches). So it can't be a legal tax. Yet if it isn't a tax, it then becomes a mandate to force people to buy something, which is unprecedented and comes back to unconstitutional as requirements for purchase are in the *States'* purview, not Federal.

I think SCOTUS has opened itself up to a challenge of their own ruling by going beyond their Constitutionally granted boundaries into declaring something a tax without congressional approval or vote.

Re: your last paragraph, Draug, I don't see how. Congress passed a law. The Supreme Court is welcome to find it Constitutional under any relevant clause that might apply. Congress doesn't have to select it.

I agree with the sentiment of what Obama tried to do but what you have ended up with sounds a bit messy, you gotta keep it simple to keep costs down.
Of course as soon as you get private health insurance companies involved you know things ain't gonna be cheap, that's why these guys have all the big plush head offices, insurance pays well.
Rather than force people to take out separate insurance why not fund the whole scheme via general taxation, or is that too communist ??

"Rather than force people to take out separate insurance why not fund the whole scheme via general taxation, or is that too communist ?? "

It's not that it's communist or socialist, but some of us prefer to have better coverage than the default deductibles and stuff and we should have that option. My employer offers three plans. A very basic high deductible plan eligible for HSAs (Health Savings Accounts which allow you to save the extra you don't use for retirement each year) and two FSA (use it or lose it in the year Flexible Spending Accounts) eligible plans: a basic $500 per person $1000 per family capped at $2500 per personal/$5000 family out of pockets and a plan where these deductibles and OOP caps are cut in half. I choose the third with the lowest deductibles and OOP. Do you think the government plan is going to give me that?

@Semck - The issue is that Congress didn't pass a tax. Only Congress can pass a tax. If SCOTUS decides the *only* way something is not unconstitutional is if it is a tax, then it has to go back to Congress to be passed as a tax. They send things back all the time. But they didn't here. Why? Because they knew even a friendly Congress would never pass that as their constituents would vote them out.

@Draug,

"@Semck - The issue is that Congress didn't pass a tax. Only Congress can pass a tax."

Congress passed a law. It is up to the Court to decide whether it is a tax.

Perhaps you are referring to the fact that taxes have to pass the House first, and Obamacare didn't. If you mean that, then I agree that is very odd.

It doesn't have to pass the house first, bills, even taxes, can originate in either chamber but it is a prerogative that the House likes to keep a hold of. So the bills are usually changed by the HOR if they originate in the Senate. The only reason it didn't with the ACA was the Dems in the HOR passed the Senate bill intact to avoid another cloture vote in the Senate.

@semck - The ACA, as passed by congress, did not have a tax. It had a penalty. Congress simply did not pass a tax. And no, it is not up to the court when the wording says:

"‘(b) Shared Responsibility Payment-

‘(1) IN GENERAL- If an applicable individual fails to meet the requirement of subsection (a) for 1 or more months during any calendar year beginning after 2013, then, except as provided in subsection (d), there is hereby imposed a penalty with respect to the individual in the amount determined under subsection (c).

‘(2) INCLUSION WITH RETURN- Any penalty imposed by this section with respect to any month shall be included with a taxpayer’s return under chapter 1 for the taxable year which includes such month.

‘(3) PAYMENT OF PENALTY- If an individual with respect to whom a penalty is imposed by this section for any month--

‘(A) is a dependent (as defined in section 152) of another taxpayer for the other taxpayer’s taxable year including such month, such other taxpayer shall be liable for such penalty, or

‘(B) files a joint return for the taxable year including such month, such individual and the spouse of such individual shall be jointly liable for such penalty.

‘(c) Amount of Penalty-
"

So you see, Congress passed an unconstitutional penalty. Activist judges declared it a tax.

http://www.govtrack.us/congress/bills/111/hr3590/text

That is the full text of the ACA.

Draugnar,

Yes, I'm very familiar with the case. But the Court ruled that the penalty was *functionally* indistinguishable from a tax, and that since function and not form typically matters in Constitutional law, it was valid under the taxing clause.

I admit that it was a somewhat strained decision (I'm not a big fan of it), but there's certainly nothing *conceptually* wrong with the Court declaring that an act of Congress is a valid tax even though it didn't use that word. Congress doesn't have to use the word tax.

@Semck - only you are 100% wrong that is "functionally" indistinguishable from a tax.

A tax is something that happens to you as a result of ACTION. i.e. I work to earn money, and part of my action is sequestered for government use. Or, I make a decision to purchase, something, and some part of the purchase price is given to the government.

In this case, you are being penalized for INACTION. If you do NOT purchase something, you are now penalized. I don't know how anyone can possibly consider this a tax. There isn't a single thing I can think of that mimics this is current tax policy - it is not a tax, it does noes resemble a tax, despite what SCOTUS says.

The ACA doesn't do nearly enough to address the main issue of ever-larger premiums being paid to insurance companies, and ever-more medical claims being denied payment by insurers. In fact it forces everyone to do business with these insurers. I don't see how anyone (liberal) who supports universal health care can accept this. In fact I would guess even conservatives would prefer straightforward socialized health care to this arrangement. It's basically just a payoff (now) to insurance companies to get a promise of better behavior from them (later) because "we've got to do something." They should have done something to reverse the spiraling costs first, at least the payout would have been lower. The legislation itself is too complicated to have a predictable effect. We'll see what happens.

@tendmote - Your are absolutely right -- if the purpose was "affordable" health care, all indications are that health care costs are going to skyrocket for people. -- the long term affect will be further degredation of the economy, which will cause more people to *lose* health insurance coverage...

...then again, that *was* the desired affect by design. The purpose of this bill has *always* been a half-step towards single-payer, 100% government run health care - so the purpose of this legislation has *always* been to destroy the private sector health insurance industry.


Ahhhh....what a great country, when a government can target private jobs for destruction....and all the good sheeple say "Bah-ah-ah-ah-ah-ah-ahh...."

@krellin "when a government can target private jobs for destruction"

Well, whoever has the job of changing around all the billing codes for the medical procedures, and the other person who denies insurance claims because of incorrect billing codes, and the clerk at the doctors office who submits the same procedure eight times under eight different billing codes... well, there's a lot of inefficiency in the system that the "free market" isn't wringing out because the consumers are under duress of disease/death/bankruptcy if they take any chances. Deeper still people are at risk of all those things if they voluntarily leave a job (e.g. to start a business.) Government-run health care would be a boon to entrepreneurs (like free air is.) I'm totally against the government intervening in the economy picking winners and losers with selective investment (and amateur-hour venture capitalism e.g. Solyndra) - but I'd put health care in the same category as public schools and the military as something the government should actually do.

"so the purpose of this legislation has *always* been to destroy the private sector health insurance industry"
Anecdotal evidence would suggest that even a universal health care system would in no way 'destroy the private sector health insurance industry.'
In fact the two can work hand-in-hand and compliment each other, you need a sense of perspective and a dose of reality here, these things are not as revolutionary as you may think, modern social democracies in Europe seem capable of running such health care services side-by-side, why should the US be incapable of such a feat, especially with all of that cheap immigrant labour in the country.

@tendmote - do you know anything about the automotive industry? IT doesn't matter what vehicle you drive, or where you take it to be fixed - any vehicle sold in the US can be hooked up to a generic scan tool, which will spit out required infomation about the vehicle - trouble codes, basic diagnostic information, etc - so that any technician in any shop can fix anyone's car.

With a few very simple regulations which basically say, "Here is the list of diagnostic trouble codes, data with scaling, that all generic scan tools must be able to read" we have created a systems that provides a beneficial service to any vehicle owner, and compliance by all automobile manufacturers is 100% without issue.

It's really not that fucking difficult a concept to regulate billing codes and streamline billing systems, etc.

The fact that the ACA addresses NONE of this is proof in the pudding that it was never intended to reduce the cost of health care to begin with.

@nigee -- you are wrong again. If the government is the primary interface and payer for health insurance, then the concept of "private health insurance" becomes a joke - a name-only adventure. It's essentially fascisim, wherein the government co-opts the industry, calls it "private" but absolutely controls it.

The idea of profit - which is the core function of private industry - disappears.

@NBaby

"Anecdotal evidence would suggest that even a universal health care system would in no way 'destroy the private sector health insurance industry.'"
I agree.

"why should the US be incapable of such a feat"
Because of incomprehensible legislation such as the ACA. Just because it's labeled as a solution to a problem doesn't mean it is. Do you believe that people in government are really our "elders and betters", NBaby? I don't consider the ACA to be nefarious plot but the ACA is costly buffoonery. We'll be revisiting the problem, I'm sure.

"all of that cheap immigrant labour in the country"
What's the point of that statement?

@krellin "It's really not that fucking difficult a concept to regulate billing codes and streamline billing systems, etc."

Really? Are you saying because "It's really not that fucking difficult a concept " it's as good as solved? The insurance companies *have no incentive to stop doing that shit*. So the problem persists, and doctor's don't get paid, so they jack up prices for the things they can get paid for, and on and on it goes until the prices become absurdly large and the likelihood of a bill becoming paid becomes random.

Don't confuse "simple concept" with "straightforward implementation" when the incentives align with "fucking with the process."

@tendmote " The insurance companies *have no incentive to stop doing that shit*."

Moron....di dyou read what I wrote? The Feds regulated trouble codes and data...they made a list, published it, and said if you sell cars, this data hasto be available. It is in NO WAY beneficial to a car manufacturer to use common data - it means your car can get services anywhere, instead of using prorietary-only data that requires your car be serviced in the dealership.

And yet, the system works damn near perfectly.

Of course it isn't in the insurance companies interest...THAT WHY THE ACA SHOULD HAVE ADDRESSED THIS ISSUE. What the fuck is so difficult to grasp about that. It's yet another point in which the ACA fails, in which it didn't even attempt to address a huge cost issue in the health care industry.

You act like that government putting out a list that says "Adminster Aspirin -- Code AA1" and so on is a difficult concept or difficutl to implement, or whatever.

Difficult concept -- not at all
Difficult to implement? Not at all...billing codes exist -- thre would be a transition period, which should have started 3 years ago when they passed the legislation, which would have been completed by now

This in no way "fucks with the process" -- it means the process becomes standardized for anyone wanting to do business. Not difficult to understand, not difficult to implement, reduces confusion, reduces chances of fraud, would be beneficial for everyone.

But people like you become the problem. First and foremost, you are illiterate. I never said it is as good as solved -- I said it's a simple solution, which has been implemented in other industries, that would streamline the billing process and reduce fraud, and would be generally easy to implement....But "as good as solved?" WTF. Never said that....but it ***could be as good as solved*** if three years ago this had been addressed in the legislation that was intended to fix health care and reduce costs.

@krellin

"Moron....di dyou read what I wrote? The Feds regulated trouble codes and data..."

Dipshit... how can you look at an insurance industry that has influenced the government to *pass a law that forces people to be their customers* and be so confused about who has who by the balls? Regulating a bankrupt auto industry is one thing. The insurance industry isn't quite as easy.

Krell - "@nigee -- you are wrong again. If the government is the primary interface and payer for health insurance, then the concept of "private health insurance" becomes a joke - a name-only adventure. It's essentially fascisim, wherein the government co-opts the industry, calls it "private" but absolutely controls it.
The idea of profit - which is the core function of private industry - disappears."

Evidence from countries that are already doing this would suggest otherwise. I'm just informing you of the reality, not what I think might happen. Anyone can supply health care if they have people willing to pay for it, just like many other services.
The way the govt have gone about it sounds very messy but probably as a result of what you already had in place. It does sound like it can be much simpler, I think first the American people have to believe it is possible before you can make it better, the Democrats are still trying to win the argument, I have no doubt in 20 years it will look very different.
The idea of a universal scheme does not crowd out private heath care at all.
Also healthcare is very vocational. Many professional people are not just driven by money when deciding a career, that is not the primary motive for all.

@NBaby regarding "The way the govt have gone about it sounds very messy but probably as a result of what you already had in place"

What we have in place is a system of government that was never intended to work efficiently. By design it is supposed to be saturated with conflict and offsetting powers and responsibilities. It's not geared toward providing services to people.

Wait a second, there's a lot of new info here krellin....

You say the individual mandate had been struck down. I though that they had settled on a "you must have healthcare or pay a fine," option. So though by the letter of the law perhaps you are correct, in function next to nobody is going to elect to pay that fine.

The rest of what I said presumes you agree that every person should have healthcare (maybe I should not have said universal, because that word has implications of full government control). If you do not agree that every person should have healthcare, I've already invited you to die in a fire :) If you think that what the uninsured have at this moment qualifies as healthcare, I also invite you to die in a fire.

I view this as an entitlement, whether we arrive there through the government or the private sector I don't care. The private sector has made it clear that it has no intention of getting everybody coverage.

http://www.salon.com/2013/10/18/inside_the_fox_news_lie_machine_i_fact_checked_sean_hannity_on_obamacare/

I found this interesting article. Is it this kind of "journalism," I wonder, that makes otherwise reasonable people like krellin believe obamacare has failed before it even starts?

""you must have healthcare or pay a fine," "

Nope, SCOTUS changed it to "we will tax you if you don't have health insurance" because, as a fine, it was unconstitutional. So SCOTUS decided to cut the administration a break and interpret the law to be a tax, despite having the word "fine" clearly printed in it (I copy/pasted the text previously of the offending section). And please, do not confuse health care with health insurance. One is the actual caring for the patient at a fee, the other is a means of paying that fee by paying into a corrupt scam of a system, a middle man as it were.

That's fine, Draug, but what we call it is just semantics, . The point is that the individual mandate is functioning (via dirty tricks, if you like) but functioning, and so my claim that everybody shall be covered is still accurate, yes?

The second part of your post I don't have a real response to. I accept that health insurance does not guarantee health care, if that's what you want to hear. A fairly meaningless statement though, since lacking health insurance guarantees none. If you hope to be convincing that its a "corrupt scam of a system" you'll have to do better than just saying so.

FWIW, by the way, I actually agree that insurance is generally a scam, by it's nature. The solution is universal health care, but that doesn't seem to be an option yet.

AT YellwoJacket -- the "individual mandate" is not working AT ALL. The concept of the individual mandate was that every single American would be *forced* to *purchase* health insurance.

UInder the ACA, we suddenly have the internet "health exchanges". Do you have any idea what they are? It's just a bunch of policies that you can - BY CHOICE - go on line to purchase from private insurers.

Guess what -- you could have purchased insurance BY CHOICE from these insurers before if:
1. You wanted to
2. Were able to

With the passing of the ACA, the people that Did NOT choose to buy insurance or were UNABLE to buy insurance are the same people.

So the reason we see no rush to purchase health insurance is because people don't want to still don't want to, and the people that couldn't' afford it 3 weeks ago still can't afford it.

Thus, the ACA is a failure from "Go!" because it does nothing to change the situation and/or reason to buy health care.

Add to the all the anecdotal (and factual) evidence that the single-purchase health care plans people are finding on the ACA web site are *massively* more expensive that plans from a month ago, and it basically means that more people will *lose* insurance in the long run as private, single plans convert to meet regulation.

The "tax" / fine whatever you want to call it is not an individual mandate...it is a tax. If you choose to pay the tax/fine, you are *not* magically covered by health care....when you go to the hospital you will not magically have government health insurance...you will STILL be uninsured....just uninsured and paying another tax/fine.

So by any measure of the intended affect of the ACA, it is a *failure* from the start, primarily because the Individual Mandate was rule Unconstitutional, and without it, we still, 3 weeks in to the program, have essentials the same 40+ million uninsured Americans, and no reasonable expectation that a struggling single-mom is suddenly goign to find another $300 a month to buy insurance...

So Obamacare is an absolute failure from the start, as it is so structurally deficient as to *never* solve the problem until such time that the fine/tax for not being insured is larger than the (ever-increasing) cost of health insurance.

But *nobody* gets free health insurance out of the deal, and nobody who couldn't afford it before can afford it now.

Again, krellin, that's a lot you are saying, and I'm not so sure it's all correct.

First of all, ACA allows states to put people below the poverty line on medicaid, so they are, in fact, getting free health care (if the states accept, which some don't, but don't blame ACA for stupid governors). That is HUGE.

This is the second time you've claimed that premiums are skyrocketing. How do you know this is true? You are basically saying that nobody's premium will go down. That is a hell of a claim and I want to know why you feel justified in making it.

What percentage of people will elect to pay the tax and forgo health coverage? Close to zero? So in EFFECT, if not in fact, the individual mandate is successful, right?