Forget Baby Einstein,  Listening to these grandparent types discuss this issue put me right to sleep.  Play it for your child, who knows, they may end up on the Supreme Court,  The justices are behind the times, broccoli is out, chocolate is in.  Why is Chocolate really good for you? I bet, because it is expensive.  And if you can afford chocolate, you most likely also can afford whole foods such as fruits and vegetables.  You may eat less process meat, and most of all, you probably have health insurance.

Which brings me to my main point, what this issue is really about is the minimum wage.  Should the minimum wage include health insurance?  I think it should.  Look, we are going to pay off our national debt with inflation, we better index the minimum wage to something that keeps the poorest in our workforce alive, it is necessary to prevent a revolution.  This law will decrease the wage gap, and it is the right thing to do.  No, it doesn’t do any of this directly, but the mandate creates the situation where health is considered part of life, liberty and the pursuit of happiness.  Eat Chocolate, we can afford it. Feed the people a living wage.  We can’t afford not to.  If sugar cost as much as honey, and oranges were cheaper than soda, maybe we wouldn’t be spending 19 percent of our GDP on sickness. �
Sweat Dreams.

If Obamacare is so great,

then Barack Obama, Harry Reid and Nancy Pelosi need to sign themselves up and their families for Obamacare.

Oh that’s right, Obama, Reid and Pelosi as well as every single democratic member of Congress made themselves EXEMPT from Obamacare.

When Obama, Reid and Pelosi sign themselves and their families up for Obamacare, as well as every single democratic member of Congress, then maybe I’ll consider whether or not I want Obamacare forced down my throat by some bogus unconstitutional goverment mandate.

I would be curious to hear the guests’ comments on the following:

If the government can force private hospitals to treat those in need of emergency care, then they are basically mandating that private sector actors to do business with one another.  I don’t see the difference between forcing private providers to give unpaid emergency care and forcing private recipients to pay for insurance.  Both are forcible transfers of resources between private “people” (corporations are people, aren’t they?)
Isn’t this the same problem, but in reverse?  The only difference seems to be that the electorate would not accept a system in which hospitals didn’t have to treat those in need of emergency care.  But aren’t these legal questions supposed to transcend popular politics?The parallels that Scalia draws between food and health care markets would be more applicable if the government forced grocery stores to give food to those who walked in and said that they are hungry.  

For Obamacare opponents : a question: �
How can you be opposed to the penalty mandate on one hand, and on the other, reconcile how it is otherwise okay for the uninsured to cost families – with coverage – upwards of $1,000 dollars a year in hidden premiums?
Another way of asking the question: What bothers you more – requiring everyone to buy health insurance – or – having to pay more on your own policy to cover those who chose to go without?

Several of the conservative members of the SCOTUS are adept at at least
appearing obtuse.  A premier illustrative example is justice Scalia’s
insisting that young people should be able to wait until they need
health insurance to purchase it, on the rationale that they probably
need their money now more than they need health care.  Unfortunately, he
neglected to provide a list of insurers that would sell coverage to
someone recently diagnosed with a costly medical problem, or speculate
on how someone might be able to afford to purchase such insurance.  This
is but one of many threads of reasoning trotted out in the historic
case that seem to flaunt a lack of reasoned understanding of health
care.

Many issues make health care unique.  First and foremost, insurance,
like healthcare itself is not a commodity that consumers can make
rational on-the-spot market-based decisions about, because most
consumers lack expertise and information to choose between procedures
and providers, and many health care choices must be made post haste,
with little or no time to “shop around”.  Permitting some to opt out on
health insurance guarantees that society will pick up the tab when the
irresponsible parties DO need care, as many complex medical procedures
are immensely expensive and essentially unaffordable for “the 99%”.�
This unaffordability question dovetails with another aspect unique to
healthcare, namely, no other good or service is rendered by providers
who are morally bound, by the Hippocratic oath and by the doctrine of
every religion, to provide their “product” (health care) to those who
need it, whether or not the consumer can pay for it.  This, of course,
makes for a situation where providers either agree to “eat” the charges,
and/or pass on them on to society as a whole, and this in turn leads to
the games played by hospitals and insurance companies where rates for a
given procedure can vary widely, with the highest price being reserved
for the uninsured, out-of-pocket payers.  In addition, the need for
healthcare is partially a matter of luck (good genes or bad,
unforeseeable accidents, etc) and partially a matter of choice, either
in terms of the procedure being optional (nip-tuck, for example), or the
need being related to lifestyle choices (excessive eating, not wearing a
helmet while motorcycling, etc.).  Finally, society has not yet tackled
to question of what health care should be provided for all, and what
care is too expensive and/or to “low yield” (successful in too few
cases, or extending life without regard to the quality of life or the
duration of the extension) to justify covering it for everyone.  In
short, we know how to do a lot more than we can afford to do for
everyone.  Grappling with this will get perilously close to setting up
the “death panels” that hysterically charged the health care “debate” in
its last iteration.

Our inability to maturely and dispassionately discuss what makes both
clinical AND economical sense is the key to comprehending our failings.�
Our human urge to be compassionate conflicts with our American notions
of personal choice and our “free market” ethos.  Other manifestations of
this includes the rate of compensation for specialist MDs, profit
margins for drug and medical device companies and the insurance
industry, and malpractice damage awards.  It may boil down to this: some
human endeavors do not belong in “the marketplace”.  Exercises in
compassion cannot be “for profit”.  Any linkage between publicly traded
companies, with fiduciary responsibilities to stock holders, and people
in medical need, is fundamentally morally corrupt because it seeks to
profit from human suffering.  In this sense, “Obamacare” has got it
wrong.  But it is no worse than the conservatives’ arguing that
government should step aside and let the marketplace rule.  We have a
problem here.  It is growing in scope and severity, and until it is
resolved, it will damage our competitiveness, but our spiritual health
as well.

Republicans are really going to screw Americans on Health Care!

25 years ago, Republicans and Dems BOTH knew health care was going to eventually bankrupt America because costs were rising MUCH TOO QUICKLY.

… that is why REPUBLICANS developed all the ideas Obama used to craft the Affordable Care Act… REFORM WAS BADLY NEEDED!!!

Here we are, 25 years later, and Republicans have turned their backs on the ideas THEY THEMSELVES DEVELOPED!!!!

If Republicans succeed in scrapping the Affordable Care Act, THE ONLY SIGNIFICANT HEALTH CARE REFORM since REPUBLICANS CAME UP WITH THE IDEA (BASED ON NEEDED REFORM!!!), America will be right back in the old pattern of health care costs rising 10-20 percent per year, eventually pricing EVERYONE but the wealthiest Americans OUT OF THE SYSTEM!!!

You rank and file Republicans are only going to realize the stupidity of your leaders’ hypocritical decision AGTER IT’S FAR TOO LATE FOR US ALL!!!!

It’s exactly like the government forcing us to buy broccoli!  … If my grocery bill was $2000 but my broccoli owner discounted grocery price was $300 and my copay was only $30… and the grocery store was forced to provide groceries to those who came in, had no broccoli and couldn’t afford the groceries.  The government would then pick up the $2000 price for those groceries.  Or perhaps I was hungry, then I wouldn’t be allowed to buy broccoli on my own because they knew my grocery bills would be high based on my pre-existing hunger.

Say GOODBYE to social security if the REPUBLICAN ROBERTS COURT strikes down the Affordable Care Act!!!

… the same logic will apply to SS… namely, how can the government force Americans to buy into a retirement plan?

Republicans and the Roberts Court are going to finish the job they started of bringing middle class America to its knees!!

It sure looks like Republicans don’t want a solution. They repeat the ‘free market’ mantra  mindlessly.  When healthcare becomes unaffordable, which is in the not too distant future under current free market regulation, what will they say then? We’ll see how much support they can rally. We need a solution, and not in the most inefficient manner possible – via private health insurance: we cannot continue to  afford to redistribute wealth to C-level executives with profits on 50$ cotton balls.

There is no traditional liberal Democratic dog in this fight.

The ACA is the produce of elite far right think tanks. It is totally run by private insurance corporations, private hospital corporations and private drug and medical device corporations. It doesn’t have a shred of socialism or, moronically, “gub’mint takeover of the entire health care system”.

I’m not comfortable defending the ACA, but I think it’s a baby step in the right direction. It is way too complicated, because our moderate republican, compromising President has run away from single payer to a system run by the private sector.

Meanwhile, the extreme right, ie the current GoP, hates their own former ideas now. I suppose they’e not brutal enough or don’t transfer enough $ to the oligarchs.

The argument about the mandate is nonsense. There may be a right to not buy insurance, but essentially everyone who is uninsured runs to the ER when they need it, and I have to pay for it with higher premiums. I grant the right to anyone who signs a binding contract to never use resources they can’t pay for. Such individuals may show up in hypothetical arguments but there are so few, if any, of them in the real world that there is no point in discussing them. The hypocritical galt wannabes who don’t insure and run for the safety net in a crisis are a cancer on the USA. I’d be happy to tell them to drop dead if they don’t have the cash. They have no “right” to go to the ER on my dime, so let them pay their dam mandate.

Given the slant of the current GoP, I’m sure they envision a USA in which the 1% are veritable superbeings with all the sci-fi advances that will be coming, robotics, implants, nanomed, etc, and average Americans get by on band-aids and aspirin.

 Mass. Grasps For A Cure To Rising Health Care Costs
http://radioboston.wbur.org/2012/03/15/health-care-costs

Health care costs are rising too fast. On that, there is iron-clad consensus. Where there is no agreement is how much wouldn’t be too fast. In other words, what’s a rate of medical inflation that we can all live with?

A debate about that question has been taking place behind the scenes in Massachusetts for some time. But it’s been thrust out in public now as some high profile groups stake out very different positions

http://bostonherald.com/business/healthcare/view/2011_0623blue_cross_cries_foul_over_ags_cost_report

Health insurance giant Blue Cross Blue Shield of Massachusetts came out swinging yesterday in response to Attorney General Martha Coakley’s scathing report that found the firm’s plan to lower costs actually made prices soar as much as 36 percent.

Blue Cross to rebate former CEO’s severance to members

The board of the state’s largest insurer, Blue Cross Blue Shield of Massachusetts    , has voted to rebate $4.2 million to health insurance customers, after an investigation by Massachusetts Attorney General Martha Coakley into the severance package awarded to former BCBSMA CEO, Cleve Killingsworth.

Members will receive a one-time reduction in premiums of a little less than $2 per member, which will be noted on the individual or employer’s bill.

http://www.bizjournals.com/boston/news/2011/07/06/killingsworth-severance-returned.html

They keep using the ol’ slippery slope argument. That’s the GOP standard for everything. If we’re going to use that one, how about, if the government can mandate that a woman must have an ultra-sound and that she has to pay for it, what next?! Will they be mandating that a woman must have lots of babies?!

The government can force you to give them N dollars and then spend it on X, whether you are going to use X or not.  But they can’t force you to spend the same N dollars on a range of X, Y, and Z of *your choice*?  What sort of sense does that make?

The individual mandate is a complete subset of the power Congress has to tax and spend.   There is absolutely no sensible argument otherwise. 

More get waivers of health insurancehttp://www.boston.com/news/local/massachusetts/articles/2011/02/07/more_get_waivers_of_health_insurance/

Massachusetts regulators granted more exemptions last year to residents who said they could not afford the health insurance required by the state, waiving the tax penalty for more than half of those who appealed, according to state data

Of the 2,637 people who applied, 63 percent received an exemption with 107 cases pending, up from 44 percent the previous year.

BCBS-MA Plan Jacks Up Copays at Hospitals on ‘High-Cost’ List

http://blog.corporateresearchgroup.com/2011/02/16/bcbs-ma-plan-jacks-up-copays-at-hospitals-on-high-cost-list/

Blue Cross Blue Shield of Massachusetts (Boston) is reporting unprecedented interest in a new health plan that jacks up member copays for procedures at 15 hospitals on its list of “high-cost” facilities.According to a spokeswoman, nearly 30% of BCBS-MA’s small business and individual clients renewing in January 2011 signed up for the Hospital Choice Cost-Share plan.  Typically, a new plan option attracts just 1% to 2% of BCBS-MA businesses in the first year.  A separate BCBS-MA tiered network product called Blue Options – launched in 2007 – has 95,000 members.

i’m listen to the audio tapes before I listen to this show – it’s really interesting!

It is exactly this type of program that is indicative of the ‘liberal bias’ that so many people recognize in NPR.  While not overtly coming out and stumping for the administration’s position it is so painfully obvious from the types of things that Tom says and doesn’t say, the amount of time he spends on each side of the issue, the threads that he tugs on which support one side or another that Tom is clearly alarmed and disappointed not only in the possibility that the Supreme Court will rule Obamacare unconstitutional, but even at the rigorousness of their questioning. 

It’s sad really, but I have more respect for someone who comes right out and states they support one side of an argument than one who positions themselves in the noble position of unbiased journalist when nothing could be further from the truth. 

The fact that the vast, vast majority of NPR staff does exactly this same thing on a daily basis makes truly open-minded consumers like me sad and jaded when it comes to taking NPR seriously.  

That guy that called in from Cambridge claiming gov’t overreach into most intimate of personal affair all of a sudden must not be paying attention to the right-wing moral encroachment on a woman’s right to an abortion or the right of anyone to marry whomever they like or the right of anyone to practice or not practice religion. Aren’t those encroachments into our personal lives far more nefarious than wanting every citizen to have access to healthcare?

Why can’t we compare this to national defence. The government provides national defence and requires us to pay with our taxes. There are lots of private companies producing defence equipment and we are not able to opt out of national defence costs.

Ron Paul, when pressed by Wolf Blitzer’s debate question, couldn’t balance his stance for personal responsibility to not have to have to buy insurance with not treating a dying person coming into the ER  without insurance. He offered no alternative.  Isn’t personal responsibility also NOT being a burden to others?

I really wonder how many people would gladly pay to be in Medicaid?  I know quite a few.  Get rid of COBRA, which is still unrealistically high for people that have lost their jobs, and let those that lost their insurance (and likely jobs) but don’t need to be on social services yet, be able to buy affordable insurance, perhaps based on their finances at first.  When then get back on their feet, let them have to option to buy into Medicaid if they choose to, as they might not be able to get, or afford, insurance through their job, or perhaps they’re happy with the services through Medicaid.

***

About the caller Steve in MA point – Maybe not a mandatory checkup, as that would seem far reaching. But wouldn’t it be a good idea to have everyone get one free checkup a year? That would catch problems before they could get worse, like my cancer was. How much would that save by catching things when they are small and possibly easier to fix, or preventing a problem before it arises?  In return , pay the healthcare provider quick and easy – Send in the from (one form) and get the turnaround on payment in days, not weeks and months. 

All of us need to bathe. How many people slip in the bath tub and injure themselves every year, raising insurance costs? Should the government require everyone to buy non-slip tub mats?

To Justices Scalia and Kennedy who raise the broccoli question, I say that the price, consumption or lack of access to broccoli is irrelevant.  Nobody in their right mind would suggest that what’s going on in the broccoli market is economically unsustainable or morally indefensible.  Furthermore, if we recognize health care as a fundamental right, then why is it surprising that the relationship between the individual and the fed. govt. would change in a fundamental way?
�
The classical laws of supply and demand that libertarians want to apply to all sectors of the economy simply do not function well in the health care market.  Here are a few reasons why this has always been the case: 

1) Accident and illness are largely unpredictable and purchases of health care cannot be planned as with other goods and services.

2) Third-party payment whether private or public distorts consumer decisions based on net vs. actual gross cost of health care purchases.

3) Medical information is asymmetrical, that is, too expensive and beyond the reach of most consumers.  Entry into the medical profession is limited; medical education extremely expensive. There are obvious monopolistic and oligopolistic forces in the medical sector that impede price competition, limit supply/access, and add to runaway costs.�
 �
4) Private insurance incentive is to shrink the risk pool to include only the young and healthy, and to dump elderly and sick customers onto public or charitable programs.  Public health model is the opposite, that is, to increase the risk pool to include everyone, thus providing a more humane system as well as more efficiency (expenses are borne by everyone).

5) The prevailing view in our society that health care is a human right leads to the provision of life-saving emergency care at all hospitals and the free-rider problem that Ron Paul addressed in such a stunningly amoral manner.  The “individual mandate” does provide a morally acceptable solution to the inefficiency and irresponsibility of the cost shifting that occurs when free-riders seek life-saving treatment. 

Justice Kennedy ….. had he practiced medicine for a lifetime, as I did, and seen the sadness and cruelty of people who could not get medical care because they had neither money or insurance, he would believe that the “heavy burden of Justification” (for govt action) has been met.

I thought the mandate is you must buy health care. But It seem if you don’t have money then that “Mandate” is not a “Mandate”. So it is not a “Mandate”. That cost will still be passed along to people who buy health insurance.

I can’t understand why anybody wouldn’t be in favor of state-run health care (Obamacare),

just look at how well it’s worked in Cuba and North Korea.

All those death panels which are set up under Obamacare should help save the federal goverment a lot of money,

cutting off medical coverage to old people and people with a terminal illness will be a big time money saver for the federal goverment. 

I have not heard anyone mention that the main conservative argument against against the ACA health insurance mandate is a slippery slope fallacy.  It is just silly to suggest that if the Court finds the mandate to be valid that there will be no limits to Federal authority.  The Court could easily write a narrow opinion that validates the mandate but leaves plenty of room for finding future limits.  The argument about limits is simply illogical; i don’t see why anyone takes it seriously.  Of course health care is different from other markets: for one thing, people buy health services, not products, so the analogies w/broccoli and cars are off-point.  The analogy w/police and fire services are much closer.  If the mandate or the entire law are overturned, the Court should also void the federal statute that requires health providers not to turn away people w/out insurance.  Let’s be honest: no insurance, no service!

I am confused, there are 50 million uninsured and up to 4x poverty can be subsidized? How is that supposed to bring in money to pay for everything else? It feels like a break even or negative. So to me the argument that we need uninsured to pay  for this to work is bogus. What am I missing?

The current system is designed to deny you coverage. Yet despite that, you want to keep wasting your time, money and possibly die from lack of coverage?

If you died from lack of coverage, would Obama or any of the other Powers that Be care about that? No they wouldn’t.

Obamacare involved some compromises that I personally did not want to see.  However, given the political reality, it was just about the best reform that could be obtained. 

One of those compromises was the “individual mandate”–an idea dating back to George Bush Sr. as an alternative to Dem proposals based on an employer mandate.  Later, even the Heritage Foundation endorsed the notion of an “individual mandate.”  Funny, there was no outcry from the limited Govt., strict constructionist, ultra-conservative types at that time.  It’s amazing to me how a few decades lapse, a slightly left-of-center President who happens to be African-American gets elected, and all of sudden one of the pillars of his reform threatens to undermine our liberty when it was the self same liberty-loving conservatives who originally proposed the idea.  I suppose they’ve been getting down with their etch-a-sketch tablets a lot lately. �
�
If the Supreme Court issues another perversely partisan decision this time to gut AHA, I guess besides the economy, the Nov. election could be a referendum on whether we want meaningful reform of a broken health care system (i.e. Medicare-For-All or some other form of single-payer) or are we going to acquiesce to the intransigence of Ayn Rand-inspired conservatives and their corporate cronies who will fight to protect the status quo at any cost.
�
If AHA is struck down, our only hope to address the national disgrace of 40-50 million uninsured may be to re-elect Obama, give the Dems control of the House as well as a filibuster proof majority in the Senate, and hold their feet to the fire.

While we all know NPR leans to the Left, some of their programs manage to be more objective than others. Those that aren’t, like this one, remind me why heavy bias is bad: it prevents people from seeing, and understanding, both sides of the debate.  So I’ll set straight a couple of things that were mentioned but not accurately considered.
1) The idea that we are in the market of health insurance just by virtue of being born is preposterous. If that’s the case, then we must also be in the food market, since we can go by without food a lot less than we can go by without health coverage. In this light, the “broccoli” comment sounds a lot less preposterous than the program tried to make it.�
2) In California it is not mandatory to have private insurance to own a car. A driver has the option to give proof of financial responsibility by making a deposit of $35,000 to the DMV. Comparing car insurance to health insurance is flawed because the argument, intentionally or not, is incomplete. 

In my view the vast majority of problems come from the way the US keeps trying to bend backward to have its cake and eat it too. You can have a fully privatized health system, or a fully public one. As soon as you try to make some unhappy mishmash of the 2, that’s where constitutional problems will inevitably arise.

Here is a thought concerning the comment by Justice Roberts
concerning Health Care Legislation: “Can the government require you to buy
a cellphone because that would facilitate responding when you need emergency
services?”

While you are not required to have a cell phone, they are
available either free or at low cost to those who cannot afford them or
otherwise would not acquire a cell phone if the service is self-paid. To pay
for this federal subsidy a tariff (or surcharge – the Federal Universal Service
Charge) is included on the monthly statement of all paid for cell phone plans.
The issue of health care coverage, and defense thereof, should be allowed for
the same reasoning, the government is already making “nonessential” services
available for those who would not purchase it on their own.

Universal Connectivity Fee (Universal Service Fund),
Federal: Because telephones provide a vital link to emergency services, to
government services and to surrounding communities, it has been our nation’s
policy to promote telephone service to all households since this service began
in the 1930s. The USF helps to make phone service affordable and available to
all Americans, including consumers with low incomes, those living in areas where
the costs of providing telephone service is high, schools and libraries and
rural health care providers. Congress has mandated that all telephone companies
providing interstate service must contribute to the USF. Although not required
to do so by the government, many carriers choose to pass their contribution
costs on to their customers in the form of a line item, often called the
“Federal Universal Service Fee” or “Universal Connectivity Fee”.

Take note of the second to last sentence: Congress has mandated
that all telephone companies providing interstate service must contribute to
the USF. This is a private enterprise having a federal regulation imposed
mandating that services are made available to those who would otherwise not buy
the service. How are providers of insurance any different from
telecommunication providers? These health insurers are providing a service that
crosses state borders.

Nobody seems to want to tackle the fundamental question regarding health care and that is can we afford the system we have. Is having health care be 6% of our economy affordable? I think the answer is no. If we continue to send jobs overseas that used to pay some of the health care costs and continue to have a negative balance of payments problem, the health care problem will just get worse and worse. If we can’t afford Medicare and Social Security what makes us think we can afford Social Medicene. Maybe we need to export some of our sick patients to a more cost effective medical system just like we are doing with jobs.

It is a great point you bring up and well taken..here’s why I don’t want anything similar to what is the NHS…
�
http://www.dailymail.co.uk/news/article-2000824/NHS-indignity-Peter-Thompsons-body-ignored-hours-corridor-Edale-House-unit.html
�
http://www.dailymail.co.uk/news/article-1218816/Jobsworth-ambulance-boss-refuses-let-crew-treat-man-broken-lying-inches-water.html

 http://www.thesun.co.uk/sol/homepage/news/2672411/Crippled-man-up-in-arms-over-NHS.html

 http://www.telegraph.co.uk/health/elderhealth/8829350/Elderly-patients-condemned-to-early-death-by-secret-use-of-do-not-resuscitate-orders.html
 

A mesage to everyone who opposes single payer health care. If this is a bad system, please explain to me why I saved at least $10,000 over a ten year period while living abroad and using a system that promotes preventative care.

So Time magazine wrote an article a few years ago stating that insured families pay $1100 more and individuals pay $410 more to cover those without insurance. Isn’t it unconstitutional to make me and everyone else pay against our will for the uninsured? It’s the flip side of the coin.

I’m just wondering if I can file a class action lawsuit to get my money back because when I multiply that over 20 years, that’s a lot of money. Sorry for the people who don’t have insurance, but it’s the fault of those against universal coverage. If people are too ignorant to be in favor of universal coverage then I shouldn’t be responsible for picking up the tab.

http://www.telegraph.co.uk/earth/earthnews/9184693/Surgery-bans-elderly-patient-over-her-carbon-footprint.html