Health Care Ruling’s Impact

TODAY IS WEDNESDAY, JUNE 19, 2013

June 28, 2012 at 11:00 AM

Health Care Ruling’s Impact

All the implications of the Supreme Court’s health care decision. We’ll go deep and wide.

We’ll take a look at the fallout from the health care ruling. (AP)

Guests

David Cutler, professor of applied economics at Harvard University. In 2008, he was a senior health policy advisor to President Obama’s campaign.

Brian Fitzpatrick, professor of Law at Vanderbilt University. He clerked for Justice Antonin Scalia at the Supreme Court.

David Strauss, professor at the University of Chicago Law School.

Joe Antos, scholar in health care policy at the American Enterprise Institute.

Dahlia Lithwick, legal affairs correspondent and senior editor at Slate.

Supreme Court Health Care Ruling

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kafantaris

Why are we polarized over the insurance mandate when it actually makes us pay our medical bills; and gives help and dignity to millions of uninsured Americans?
“The insurance mandate is socialism, plain and simple.”�
If it’s socialism, you’d have to buy it from the government, which would also tell you what doctor or hospital to go to. But you can buy health insurance from anybody, and you can get treated by the doctor and hospital you want. What’s socialist about that?�
“Can’t you see, the government is making us buy insurance. We have no choice in the matter.”
Do you have a choice not to get hurt, or not to get sick? Why then do you want a choice not to have insurance to pay for it when you do?
States in fact already have an individual mandate for car insurance, and they have been putting uninsured drivers in jail for years.�
“That’s different. Driving is a privilege.”�
Then free health care must be a right in your book. Maybe this idea came from hospitals continuing to treat the uninsured the last half century. �
The trade off to us living in a civilized society is that we have to follow rules we don’t agree with. In return, we get great many things, including goods and services that otherwise would be unavailable. But, we still have to pay for them. The mandate makes sure that we do.
What’s wrong with that?
- Zing
  
  Sounds good to me. Show me the plan and the price schedule for New York State.
  - josh
    
    nothing has changed–go down to your local feudal lord–state farm–and pay your corporate-aristocracy.
    
    this has nothing to do with government or socialism or democracy repugnant-thugs.
- josh
  
  I don’t want to pay private corporations to profit–why do You? When will Coke be mandatory and water illegal?
  
  I am a legitimate progressive and a an independent green–and om y god-probably socialist which means compassion to me–
  
  I will not pay a private corporation–to hell with the corporate-aristocracy!
  
  If universal health care is good enough for the military and corporate appointed senators–why is too good for American citizens? Oh, because, we are not citizens–we are consumers and subjects.
  
  My question to you is: why do you accept feudalism?
J__o__h__n

If the mandate is struck down, people who could pay but don’t need to be excluded from coverage. If they want the freedom to not buy health insurance they need to realize that comes with the freedom to not have the public pay for their care.
Victor Vito

Its impact? Fodder for the chattering class. Implications? Not many real ones. We still will be left with a for profit system that screws the majority of Americans. We are not even close to figuring this out.
Terry Tree Tree

Death Panel Insurance company EXECUTEives will continue to KILL for PROFIT? Denying insurance coverage, for some obscure ‘existing condition’, that the patient had NO idea of, and physicians had NOT even alluded to, constitutes KILLING for PROFIT!�
MANY other ‘strategies’ have been used by EXECUTEives, to deny coverage, putting MONEY in the pockets of the EXECUTEives!
Did they advertise THAT on radio or Tv ads?
monicaroland

I’m upset that the individual mandate was upheld. I do not want nationalized health care. The individual mandate is simply a ploy to get businesses to “pay the fine” rather than provide health insurance. The HONEST Democrats, even the President, say that the ACA was simply a stopgap until they could get what they really want, which is single-payer. There are so many better ways to provide health care!
monicaroland

Here’s how to bring costs down: Handle health insurance like car insurance. Everyone can shop around. Policies can be bought nationally. All policies would be subject to strict regulation. The poor would get a voucher to spend at any approved insurance company they like. There would be high-deductible plans available, for the young and healthy, but with catastrophic coverage. In keeping with liberty and freedom of choice. Simple. Simple. Simple. And it keeps the government out of our hair!
- J__o__h__n
  
  Car ins. is regulated by states.
  - monicaroland
    
    But you can buy insurance across state lines. Competition is good.
  - josh
    
    not the same issue. When you drive a car–you risk damaging my car and if you have no insurance–i have to pay for it. BUt yeah–auto insurance is bullshhh–auto insurance should be operated by the people–by the state. There is a place for state in our life–where do you think police come from, postal workers, fireman, laws, military, roads, bridges, schools? Without state we have no nation and no social contract.
    
    health care and auto insurance should be state-run and universal.
http://www.facebook.com/profile.php?id=1816544 Dan Trindade

What implications will the SC’s decision that the ACA is upheld have on medical billing and the industry surrounding bill collection?
Cathy Whalen

Supreme Court upholds the Health Care law – I may actually be able to afford health insurance at some point in my life… instead of just contributing to a system that only supports the bone lazy and self inflicted “disabled” due to smoking, alcoholism, ect… I as an American citizen may actually be able to have health care for me, myself!
- Tominator
  
  Such selfless compassion. Are you another diabetic Tea Partiers, too?
JGC

Health Care Rulings Impact:

Right now, Scalia, Thomas, Kennedy and Alito are plotting the untimely demise of Chief Justice Roberts after the inauguration of President Romney.

All hail new Chief Justice Clarence Thomas!

(Stage directions: Scalia, Thomas, Kennedy and Alito all squint their eyes, rub their hands together and begin to chuckle.) “Mwahh ha ha ha ha!”
monicaroland

To clarify my position: I NEVER thought the law was unconstitutional. I just thought it was a bad law. As a fiscal conservative, I don’t like the government’s role in health care. I saw the bloated costs for Medicare when my father was dying. We see the immense fraud in the system every day. And under ACA, we saw that the chief executive can decide broad health care matters by FIAT. It happened that his fiat dealt with contraception, but I didn’t care about the so-called “religious freedom” aspect. Rather, I didn’t like the fact that any president could simply decide a huge issue for everyone. I do not want a health care system based on the Canadian or British model!
- JGC
  
  If you are a fiscal conservative, how do you reconcile your position with the fact that Canadian and other health care systems cost so much less than the American private insurance system?
  - monicaroland
    
    My Canadian friends tell me that their taxes are very high to pay for coverage, and that coverage is rationed. They often come to the U.S. to get operations. They also tell me that private businesses dropped their own insurance as soon as the government began to provide some coverage. After that, Ottawa had to take it all over.
    
    I don’t live in Canada, so I’m not sure of all this. I just know what my Canadian friends tell me, and what I’ve read in legitimate news venues.
    - Dlobaw
      
      I grew up in Montreal, Canada. The provinces control healthcare. The most recent wait in Quebec for breast cancer surgery is 37 days. My father waited 18 months for a hip replacement. Fact: if this type if waiting EVER happens here, there will be a lot of extremely angry Americans. Also, being over 70 and needing an angioplasty in Canada requires medical board approval. Do you want this here. Be careful what you wish for.
      - TFRX
        
        But per capita, Canadians pay a ton less than we do here in the state.
        
        Wait a bit more? Well, spend a bit more–which Canada uses more wisely by all accounts– and they get improved outcomes. While still undercutting less than the USA.
        
        The last thing you can say about American healthcare is a blanket assertion that spending more money on it will result in less waiting or more of anything we want.
      - JGC
        
        You assume everyone who demands an angioplasty will get one in the U.S., and immediately. Well, yessss, if you have access to health care first.
        
        I grew up in Pennsylvania and I now live in the Montreal area.
        
        Americans sometimes demand “service now!” whether or not they are being well served. Impatience is not always a virtue.
- Terry Tree Tree
  
  FRAUD is FRAUD! FRAUD is a CRIME! It NEEDS to be PROSECUTED!
  Cost of FRAUD is NOT cost of Medicare, Medicaid, or Affordable Health Care!
  - monicaroland
    
    Very true. Fraud must be prosecuted. But it seems that massive fraud is being perpetrated upon the federal government’s Medicaid and Medicare programs — see various “60 Minutes” programs and many in-depth objective news articles. The federal gov’t doesn’t seem to be able to contain the fraud. It may be the case that private insurers cannot root out fraud, either. Dunno, I haven’t read anything about that.
    - Terry Tree Tree
      
      HOW MANY Republican, or ‘Conservative’ politicians have REPORTED, or helped convict FRAUDS, that supported them? Are their ‘morals’ ONLY when they apply to someone else?
Charlie

This will bring premium costs down FOR ALL OF US!!
�
We will no longer have to cover the expensive costs of the uninsured, absorbing thier healthcare into the premiums of THOSE WHO DO PAY FOR INSURANCE!!!We will ALL save HUGELY moving forward!!Thank you John Roberts and the Liberal Justices!
- nj_v2
  
  Another dupe. Look at Mass.—costs out of control. There’s no effective cost control in the ACA system. Insurance companies are already gaming the system. We’ll get crap insurance products at ridiculous prices.
  - Charlie
    
    That’s because the scale in MA is not National!
- http://twitter.com/TongoRad TongoRad
  
  I hope so. But are the insurance companies going to pass the savings on to consumers? Think of the regulatory and enforcement expenses added at this point.
  
  At some point, hopefully very soon, Americans will wake up to the fact that private insurance companies are not adding value, and are just an unnecessary and inefficient way of distributing health care.
Bill

I believe you misspoke, saying SCOTUS ruled “The mandate is a tax”. Rather, the penalty for not complying with the mandate is that a tax will be assessed. Like the mandate for staying under the speed limit only implies you’ll pay a fine if you exceed the limit and get a ticket.
JGC

Health Care Rulings Impact, Part II:

Obama finally forgives Chief Justice Roberts for screwing up his swearing-in ceremony at the presidential inauguration in January 2009.
Worried for the country(MA)

Remember the 2010 political environment?

2012 will be 2010 all over again. This horrible law needs to be repealed. Voters will rise up in record numbers to make certain it is repealed.

That is the primary effect of the SCOTUS decision.
- Terry Tree Tree
  
  Back to Republicans KILLING people, via Death Panel EXECUTEives of Insurance companies?
  - Dlobaw
    
    This is a generalized statement and not relevant. NOT every Republican is evil just like NOT every Democrat is a saint. Why can’t people be factual and not so emotional. This would really help America come together. This is our problem. And actually, most Americans don’t get involved in this spin debate. The more you point fingers, the more that regular people ignore this retoric.
    - Terry Tree Tree
      
      With the Affordable Care Act, people NOW have Health-Care. If Republicans REPEAL it, they will be KILLING people that they deny coverage to!
      Republicans can choose to be evil, by repealling, or otherwise damaging that!
Bugsyboo

People who are saying this is a tax increase are ignoring the fact they
their taxes and their healthcare premiums are high because they’re
paying for people who are uninsured. How do they think hospitals and
clinics and insurance cos pay for the care of the uninsured? Under this
reform, we will all pay less and we will all have access to care. That
is the damn point!
- http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman
  
  This is one reason, though, some states are fighting so hard – here in MA, number of insured is very high, even before Romneycare. In places like TX, one out of 4 is uninsured, it’s going to require big changes down there to implement.
JGC

Health Care Ruling’s Impact, Part III:

Scalia blows a gasket. But, luckily, his treatment is covered by the Affordable Health Care Act.
Doug in Virginia

One of the biggest issues behind cost is medical supply companies. They charge health care facilities much higher in the U.S. than they do in other countries. This point was raised during an earlier On Point episode, sometime in 2009. I don’t believe government mandated price controls are the answer, but these kind of prices do not have the same market pressures as everyday consumer products.
http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

For decades now, hospitals have been mandated to provide ER services whether people could or intended to pay or not. This is nothing new.
AJ

Mr. Fitzpatrick, wasn’t Wickard upheld on Commerce Clause grounds? This action was not. No equivalency.
cindy

Every survey that I hear says that when Americans hear the specifics of the Act — no more pre-existing condition exclusions; children covered up to age 26 etc; then they are for those provisions even if they had thought they were opposed to the Act. And, it is the private insurers who now come betweeen patients and their doctors. Medicare is great and seniors love it and medicare is the gov’t even if some people don’t realize that. WHY don’t the dems say these simple things?
http://gregorycamp.wordpress.com/ Greg Camp

So the tax aspect is upheld, but the part that would extend healthcare to more people is in doubt? Why am I not surprised?
Jim

Where was the conservative outrage at warrentless wiretapping, or the PATRIOT act in general? Where is the outrage at NYC’s stop and frisk law? This will not lead to the mandating of broccoli-eating, as conservatives love to claim, because we are not all participants in the broccoli industry. Before the Affordable Care Act, people w/o healthcare got care on the public dime at their local emergency room. Isn’t this just a more efficient way of paying for and delivering care that we were already paying for and delivering?
DS

One of the biggest issues behind cost is medical supply companies. They charge health care facilities much higher in the U.S. than they do in other countries. This point was raised during an earlier On Point episode, sometime in 2009. I don’t believe government mandated price controls are the answer, but these kind of prices do not have the same market pressures as everyday consumer products.
Bridget

A human life is not the same as broccoli. Let’s say a person is mortally wounded. The doctor takes the Hippocratic oath to try to save that person’ s life. The ambulance arrives, the person is taken to the hospital, but who pays the bill? Is there any choice in giving the patient treatment? Because there is already an inherent mandate to try to save that person’s life, the other mandate (the one where everyone has to buy into the system) is totally necessary. A human life can not be compared to broccoli!
- http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman
  
  No one is forced to do anything – they’ll just pay more in taxes if they don’t. I have to pay more in taxes because I choose to not have dependents, but it does not mean the government is forcing me to have children.
  - Bridget
    
    Hey I’m on your side of this issue…I just get so tired of hearing conservatives comparing health care to broccoli! I believe single payer is the way to go and will follow on the footsteps of the Supreme Court’s ruling in time, especially if Obama is re-elected. Shocked that Roberts was the deciding vote…maybe there’s still some hope in the world.
http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

It’s now a 1 issue election.
- Terry Tree Tree
  
  Republican Death Panel EXECUTEives of insurance companies, versus Health Care for ALL?
Charlie

The more Americans know about The Affordable Healthcare Act, the more they LIKE IT!

This is GREAT for President Obama, as the provisions in the act will be scrutinized in the news between now and the election, reminding EVERYONE how lucky they are the law was passed!

EVERYTHING in the act does America GOOD!
Worried for the country(MA)

At least the court held up the limiting principle of the commerce clause.

However, apparently they can tax us to their hearts content.
jim

give you an example this ruling will have very little to do with the economy.

In Massachusetts we are required to buy health insurance. otherwise, we pay a penalty when we filed our taxes…

and yet, we have one of the LOWEST unemployment rate in the nation. explain to me how and why such tax would hurt us?

btw… i am elated i am not footing my personal taxes for freeloaders who refuse to buy health insurance and get free health care in ERs.
jim

give you an example this ruling will have very little to do with the economy.

In Massachusetts we are required to buy health insurance. otherwise, we pay a penalty when we filed our taxes…

and yet, we have one of the LOWEST unemployment rate in the nation. explain to me how and why such tax would hurt us?

btw… i am elated i am not footing my personal taxes for freeloaders who refuse to buy health insurance and get free health care in ERs.
Bugsyboo

Because we treat healthcare as a commodity, the only way to expand it is to require everyone to have it. If we had the dignity and courage to see access to healthcare as a human rights issue, the lack of healthcare for all would be unconscionable.
Sara

I don’t understand how electing Romney would be a way to overturn the mandate when he enacted very similar healthcare reform in his state. It is unconscionable for him to not come clean on this issue and state the obvious. Why are so many people opposed to all Americans having healthcare? Are there that many selfish, greedy Americans who have no feelings for his/her fellow man?
- MrNutso
  
  Because he wants to be President and he can’t if he supports anything he actually believes in.
Suzvt

Hooray, a glimmer of hope for those American citizens that aren’t fortunate to be born into a well-to-do family or have the good fortune to have a great job with great benefits.Don’t relax, the self centered republicans will never rest and will work harder than ever to be”fiscally responsible”and refuse to allow
the government to help those less fortunate than they.Those elite Obama bashers apparently believe poor people,people of lower I.Q.s,middle class people working full time,but without benefits are only in those positions because of the poor choices that they have made.If all American citizens cannot have health care then no public employees should get a free ride.Take away the senator’s,congressmen’s,etc.,etc.It’s very unlikely all these people outraged by a health care mandate are living and working without the benefit of very good health care coverage themselves…Unbelievable selfishness in the richest country in the world.
- William
  
  Should we not also require the same people to buy unemployment insurance to ensure they are covered for 99 weeks or longer?
  - Terry Tree Tree
    
    You don’t even know that working-class ARE REQUIRED to buy Unemployment Insurance?
    You priests have it cushy, don’t you? All the little boys you want, and higher clergy to defend and hide you, as ‘Men of God’?
Rayage

Any good chess player knows when to sacrifice a knight to win the game. The now non-partisan conservative supreme court has only set the stag for the republican party to make their case to to American voters: Give Congress and the Presidency to Us. For the record, I’m not a democrat. I don’t believe in a 2 party system. Just the greatest good cop bad cop scenario.
Rule of Law (pretty please?)

Rule of Law vs. Emotion and Good Intentions.

The perrenial existential challenge of a free, Self-Governing people, of which we are of a historically rare and fortunate few.

The confusion and lack of understanding and naiveté of so many today regarding the founding principles and wisdom of our Constitution is depressing and astounding.

It was demonstrated well in the last hour by the caller who was concerned that the ruling would give “conservatives” the ability to privatize everything that government does by forcing people to engage in commerce from private companies. That is precisely the CONSERVATIVE argument AGAINST this situation. It is well intentioned, expansive government power, discretion INSTEAD of rule of law and limited government, “liberals” who have opened this nightmare of unlimited Government/Corporate Collusion, that real Patriots, whether conservative or progressive minded as individuals have been fighting against.

Ron Paul and the liberty folks have been trying to explain, to too many deaf, and misguided ears.
- Sara
  
  I don’t know much about the constitution, but I do remember grade school. Teachers told me that it was a living, breathing document and that was the beauty of it. That was the biggest reason we could still use it to govern. This argument that is constantly repeated that “the founding fathers believed…” seems irrelevant in a lot of ways. Many of them had slaves, so should we go back to that?�
MrNutso

Romeny: Real reform! So we will get single payer.
- http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman
  
  I wish.
- feettothefire
  
  Last week that fraudulent dilettante told us he would pass “real reform” on the immigration issue. Now he tells us he’ll pass “real reform” on healthcare. But he won’t tell us what “real reform” is. Doesn’t this guy have even one courageous bone in his body?
http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

The mandate was really a second choice – single payer was thrown off the table.

As long as healthcare is about making money and not about healthcare it’s not going to get better cost wise.
Sherry

We don’t have a choice to pay taxes for our highways, whether or not we drive. How is a responsibility to pay taxes for health care “getting into our business” and for roads etc. isn’t.
DS

A great irony with the Conservatives is what constitutes too much government power. It’s fine for the government to wield power in when it suits their policies such as defining marriage.
Bugsyboo

Re: the gov’t getting into your business, then why do Rs place so many limits on reproductive rights? Hypocrite.
Charlie

If this is a tax, I’ll take it!!!I get good, affordable healthcare in return!NO pre-existing conditions can be denied, and no lifetime max can be imposed!Best deal I ever got for my tax dollars!
- http://gregorycamp.wordpress.com/ Greg Camp
  
  If that’s what it does, then I’ll be pleased, but I have my doubts. So far, it looks like a new way to do the same old things.
- William
  
  Of course, the cost of this insurance will never go up and the number of doctors that take it will be huge….
Worried for the country(MA)

Stock market sharply lower after the ruling.
- Charlie
  
  The stock market was sharply lower BEFORE the ruling!
  
  Try again!
  - Worried for the country(MA)
    
    I was following it on CNBC. You owe me an apology.
    - Gary Trees
      
      I believe they refer to this as butthurt.
    - Terry Tree Tree
      
      Trading for today has already ended? Tomorrow? Two weeks?
- JGC
  
  That may have been due to insiders hearing that J.P.Morgan may have a $9 billion loss on wacky derivative trading, not the “mere” $2 billion as reported in front of the fawning Congress a few days back. Do you think Dimon was trying to get past his mandatory Congressional appearance before the real news broke?
  
  Jamie, Jamie…?
Terry Tree Tree

Republicans have PLEDGED to KILL more U.S. Citizens, by vowing to KILL this law?
REMEMBER THIS, when Republicans are up for election!
- http://gregorycamp.wordpress.com/ Greg Camp
  
  When we peel off the shiny layers of your idol and your theology, we find out that the Left isn’t any more interested in doing good for the people than is the Right.
  - Gary Trees
    
    Great rhetoric Greg; but no substance. What exactly do you mean? What are these shiny layers? Simply because you express an aloof point of discontent with an ideology does not prove it wrong. LOGIC!
    - http://gregorycamp.wordpress.com/ Greg Camp
      
      So Terry Tree Tree can attempt a rhetorical flourish, but others cannot? He has a simplistic view that Republicans are evil, while the Left is good. I challenge that view.
      - Gary Trees
        
        I expect it from him. His views are typically over zealous and narrow minded. That should not be a justification for reciprocating bad logic.
      - http://gregorycamp.wordpress.com/ Greg Camp
        
        I didn’t. I was discussing the style of the comment, since there wasn’t much content. You may wish to review exactly what logic means.
      - Terry Tree Tree
        
        The law was passed, MORE people have Health-Care coverage! Repealing the law will take coverage AWAY, that will SAVE lives! THAT’S NOT KILLING?
      - nj_v2
        
        Kind of a skewed framework, since there really is no “left”—in any meaningful definition of the word—operating in politics today on the national level.
        
        For chrissake, the communists had an active significant presence in early-20th-century politics.
        
        The Democrats who supported this no-insurance-company-left-behind windfall are not the “left.”
        
        We have batshit crazy, full-on supporters of the richest and most powerful (the current Republicans) and we have the corporate lite party that makes populist noises, but mostly kowtows to corporate interests.
        
        There is no “left.” The House Progressive Caucus, along with a few largely isolated, marginalized senators (Bernie, et. al.) is as left as it gets.
  - Terry Tree Tree
    
    Greg, I roll out, anytime, night, day, any kind of weather, to RISK my life, for strangers in danger, for FREE! Actually, it COSTS me money!�
    I’m not interested in doing good for people?
    Have YOU tried it for over 20 years?
- Worried for the country(MA)
  
  No, no, no Terry.
  
  The GOP don’t want to kill people. Remember, they want to kill the death panels. They are saving people.
  
  Go plant a windmill to calm yourself.
  - Suzvt
    
    No,no,no Worried.
    Remember, there were no such things as”death panels”.That was a vicious lie spread by right wing conservatives who simply believed the end justifies the means.It was proven to be false for anyone interested in the facts.The”Anybody but Obama/birther”crowd obviously have no interest in facts unless they support their agenda. Go turn on Rush, he’s certain to support all of your misguided theories.
  - Terry Tree Tree
    
    DEATH PANEL INSURANCE EXECUTEives? The people giving them MONEY?
- William
  
  They have to kill the bill to find out what is in the bill.
Augustgoodspeed

A big picture question Tom: American style capitalism allocates goods/services very efficiently. The downside is that the system concentrates wealth, and in our political system that wealth can be used to lend great power to minority political views. Our healthcare economy is not efficient; price inflation is far higher than in the larger economy, and in comparison to other nations more money is buying us worse outcomes. Clearly a huge bill is coming. Now when it comes to paying this bill, for a reasonable level of care, do we really think corporations and small businesses are going to pay, as they largely do now? What would it do to global competitiveness if they did?
Merle Lenihan

Dear Tom,
As a physician who directed a free clinic for almost six years, I am celebrating this decision. The popular notion that anyone can get health care if they need it is only true for those patients deemed to have a “true” medical emergency. I hope that the discussion will turn toward our moral obligation to respond to those who are ill and injured wth compassion and empathy. In some cases we seem to have claimed that we will be ethical when we have money. In the town where I had the free clinic, our public hospital denied medical care to over 40,000 people since 2005. This hospital states that among the vague reasons that people are either accepted or denied care are based on whether the hospital and the medical school will benefit because of educational needs and “the likelihood of a favorable outcome.” In this environment our future doctors witness the turning away of uninsured people by their mentors. At this medical school, the future doctors have explained that this discordance betweeen what they are told is ethical and what they see causes moral distress. With the Supreme Court’s decision today, we have a chance at a just health care system.
Merle Lenihan, M.D.
- TFRX
  
  I’ve always wanted to ask a doctor: Is there any relationship between getting your doctorate (along with a big loan to repay) and the shortage of GPs?
- William
  
  Free clinic? How is that possible? You don’t pay your suppliers? None of your staff receives a salary? Or is it just free for the customers?
  - Edith
    
    It’s called pro-bono. This question makes no sense. Many health professionals donate their time and money to help others who are extremely needy.
Tom

As a Brit (where working people have had a required small tax on
their paychecks for decades to go towards healthcare), it is laughable to
say that this could allow the government to force you to buy broccoli
or a car. Just naive and parochial
thinking to say that .. or just plain dishonest.
- Tina
  
  I have metastatic breast cancer. I listened to the oral arguments before the Supreme Court on the radio and hearing the discussion about broccoli was completely painful and insulting. It was so filled with hurtful sophistry when there are people out here with real, painful, life-threatening conditions: many people are in worse situations than I’m in. Many kids are in worse situations than I’m in — yet several of the justices went on and on with their sick little joking about broccoli. It was truly horrid!
  
  So, I am so happily surprised by this ruling!
JGC

Health Care Ruling’s Impact, Part IV:

There is a run on pitchforks and torches in Red States.

Luckily, wounds from pitchforks and burns from torches are covered under upheld Affordable Care Act.
JGC

Health Care Ruling’s Impact, Part V:

Romney vows, when elected to Presidency, to repeal Obamacare AND Romneycare.
http://pulse.yahoo.com/_Y6CO5C2HE4WM2OYGCDVWGPRXXM oldman

Allow people to avoid the penalty by opting out of the ER mandate to provide them emergency care – let’s see how many go for it.
- Terry Tree Tree
  
  Braclet for ER, REFUSING it?
- Guest
  
  As of today’s ruling, those who won’t buy health insurance will at least have to pay, via the IRS, what amounts to an annual premium for ER services.
Sherry

One mystery–don’t the policy makers who are against this have any children or grandchildren? Odds are that they will not always be employed by companies who provide insurance. Why aren’t they thinking of the younger generation?
- Terry Tree Tree
  
  Policy makers HAVE MANDATED Health-Care, paid for by the Tax-Payers, that they DENY Health-Care to!
  - Terry Tree Tree
    
    Bracelet for Emergency Care to see that they REJECT it?
- Tina
  
  Those who are super-in-charge are possibly wealthy enough to have provided their children and grandkids with trust funds big enough to cover their health insurance costs, if they need to be paid. Your point is an excellent one, but the division between the rich and the rest of us is so great right now that their richness alone may explain their lack of vision. Possibly. This is speculative on my part.
- Guest
  
  Reputable policy makers will not allow their decisions to be guided by whether they will derive a personal benefit from the position they take; to the contrary, objectivity demands that they set aside their own possible enrichment. Perhaps these policy makers were of the opinion that everything that benefits many people is not necessarily a function of government.
- JGC
  
  Excellent point, Sherry.
- hoot
  
  If those who are so worried about “forcing” everyone to get health care because it is against personal freedoms would opt out of their cushy company-paid health care plans and go without insurance I would have a little more respect for their personal freedoms argument.
  - Terry Tree Tree
    
    Especially those on Government Health-Care, that are AGAINST others getting health-care?
Sara

I love how the prof against the ruling said, “I wish we weren’t talking about an individual case,” when the lady called in about her eye problems. That is exactly what it is all about – individuals! It is not about far-flung, abstract opinions that don’t take into account real people with real problems.
- feettothefire
  
  But that’s the essence of Republican/conservative thinking on matters such as this. We’re all on our own. Why have a system that can assure the lady gets help with her eye problem, when we can simply ignore her eye problem? If it isn’t somehow connected to the “War On Terror” or putting those pesky homosexuals in their place, why should the rest of us give a damn?
JGC

Health Care Ruling’s Impact, Part VI:

Unemployment numbers increase as CNN and FOX News fire their entire news analyst teams for misreading breaking news on Supreme Court ruling.
Worried for the country(MA)

Mr. Obama claimed the individual mandate was not a tax when he lobbied for passage for the law.

We now find out that the only way the mandate can stand is IF it is a tax.

We also learned that the Obama lawyers argued to the court that the mandate is a tax. The court apparently bought that argument. [Personally, I find that a stretch].

Does Mr. Obama owe the American people an apology for misleading everyone?
- Charlie
  
  We can ask President Obama why he didn’t call it a tax AFTER we come down on ALL Republicans for lying to Americans DAILY about pretty mmuch EVERYTHING!
Suzvt

Romney made his statement concerning the ruling of the supreme court justices. He will repeal available health care coverage to include all American citizens. No surprise, candidate Romney has never appeared to care for the lower and middle classes.He will work hard to appease the tea party fanatics as long as they hold so much power over the republican party, which seems to be allowing itself to be held hostage,and will fight to the end to keep their money for themselves,except for the pet projects they do support, like military spending. But then that works in perfectly with their paranoid conspiracy tendencies.
Suzvt

By the way,I happen to be worried for the country too,which happens to be filled with people of all kinds. I’m sure Obama is worried about our country.It’s so tiresome to hear the republicans crying endlessly about their concern for this country. They don’t even begin to have a monopoly on morals,virtues,and patriotism.It’s easy to see through these grandiose delusions they have of themselves.
A step in the right direction

There are many of us seniors who are working just to keep affordable healthcare. If health exchanges bring the cost of private care down to an affordable level – I’m retiring – and so will many others! This will open a lot of jobs – and this our country needs!
jim

I have to say…

Chief Justice John Roberts gain enormous judicial capital after his vote today…

enormous, enormous…
- JGC
  
  But how does he plan to deploy it?
jim

New York magazine:
“Roberts peered into the abyss of a world in which he and his colleagues are little more than Senators with lifetime appointments, and he recoiled”

this is exactly how i see Scalia, Thomas and Alito, basically lifetime appointed senators, not judges.
Guest

An interesting quandry: I wonder if Obamacare will require those who can’t afford insurance to obtain a health care identification card to get medical services. If so, perhaps we can solve the voter fraud and let them use this ID to vote.
- TFRX
  
  What voter fraud?
  
  Can we also use that to solve our unicorn overpopulation situation? I mean, as long as we’re fretting over problems that don’t exist…
  - Guest
    
    We need the unicorns. The unicorns are what all of those people ride who are cowered, frightened and intimidated by the thought of an ID card, although how they muster the courage to approach a unicorn is a mystery when the mere mention of an ID card makes them wet themselves.
    - feettothefire
      
      Wouldn’t an I.D card, and the requirement that we show it be an example of the big bad government getting in our faces again? I thought conservatives believed the gov. should butt out and leave us alone. Since the requirement for such a card has not been required since our countries founding, wouldn’t that represent a fundamental CHANGE, another thing conservatives detest?
      - Terry Tree Tree
        
        ‘Conservative’ HYPOCRICY? Surely NOT?
- JGC
  
  And maybe that will also come in handy in Arizona, Alabama and any other “Show your papers” states, for citizenship status on demand. (I leave the rest of this subject in depth ’til tomorrow, or another day…)
  
  Health care, citizenship, driving license, all on one card… Hey, wait a minute, that is beginning to sound a lot like Canada! Or at least like Quebec…
potter

Mr. Fitzpatrick- Cheif Justice Roberts who you say does not want to “rock the boat” did rock the boat didn’t he?

Health care should be accessible to everyone, a fundamental right. It’s a moral issue. And everyone pays for everyone’s healthcare anyway one way or another. So however the SCOTUS can allow for this to go forward, whatever rationale, whatever way forward, commerce clause, no commerce clause,if there are more battles yet- so be it.
MadMarkTheCodeWarrior

I have issues with the ACA, but I did not want it struck down… not because of politics but because of politics: not because I wanted a democratic victory, but because we need a solution to healthcare in the US, and without this foot in the door, we had no hope of the market correcting the severe flaws in the healthcare industry before the US collapses under it’s cost and not a snowball’s chance in hell of a solution coming from the Republicans other than rhetoric preaching faith in the market, job creators, personal responsibility and power of the American spirit.

Now perhaps, after being for it (when it came out of the Republican Heritage Foundation) before they were against it (because it was now Obama’s initiative), obstructionist radical right Republicans will be willing to work with Democrats to fix some of the less desirable aspects of the act such as the lack of the public option with which the government will have greater power to control costs and force hospitals and pharmaceutical companies to deliver reasonable levels of treatment at reasonable costs and force an end to the ridiculous cost shifting that masks the true costs of healthcare and underlying sources of waste. Where do I find such optimism? Someone must have slipped me some happy pills developed by a big pharma.

They had the opportunity to make this better in the beginning but the Party of No’s sole mission was not to serve the American people but to play politics by creating deadlock and at every turn try to destroy this president as McConnell and Boehner stated on day 1. The price of creating the appearance of failure, has been a highly flawed healthcare bill and a very sluggish recovery and I place that blame squarely at the feet of the radical right and the rest of the Republican party for putting party before country at one of the most difficult economic times in our history. They had the opportunity to work for us or against us and this is just one example of the results: a collection of compromises that played into the insurance industry and big pharma. But… this bill does not prevent Congress from opening the door to the public option. Perhaps vindication of ADA by the SCOTUS will open the door to compromises for better options in the future.

I am sick of the childish nonsense that the radicals in Washington pedal as fear, patriotism, freedom and democracy. Most Red and Blue are on the take in one way as they need corporate money to survive. The Red are misrepresenting us far more than the Blue. When Paul the Paver pays more on taxes on his earnings than Bob the Billionaire does on his gambling winnings on Wall Street, well… “that’s crazy.” (Ronald Reagan – see Reagan here: http://thinkprogress.org/economy/2011/10/03/333912/reagan-tax-loopholes-crazy/ It’s time to question the republican spin-masters’ lies crafted into the mythology of Ronald Reagan which is contradicted by many, many historical facts.) Today 73 percent of Americans (66 percent of Republicans) favor the Buffett rule yet the radical right
obstructed any progress on this bill:

http://www.nytimes.com/2012/04/17/us/politics/buffett-rule-debate-blocked-by-republicans.html

That is not representation, that is misrepresentation: it’s time for Republicans to end their irresponsible ideological all-or-nothing game.
JGC

The whole Supreme Court dynamic is upended for me. Did “judicial modesty” trump all? Was there a secret deal between Kennedy and Roberts to trade places as the majority pro voter for this ruling? Nina Totenberg, get on this, pronto!
JGC

Hey, DISQUS,

my “like” capability has been restored. Thanks!
- http://twitter.com/cwooley89 Charles Wooley
  
  I think one thing that we can all agree on regardless of our political standpoint is that DISQUS is pretty awesome.
JGC

Warren, Warren, wherefore art thou?
- Ray in VT
  
  He probably had an aneurism or a psychotic break.
  - Six
    
    Limbaugh moved his primary residence to his home in Florida where there is no state income tax and is reportedly in very good health.
    - Ray in VT
      
      I meant Warren, Modavations, Beelzebub or whatever one wants to call him.
- Terry Tree Tree
  
  Warren probably moved to Costa Rica, like Rush Limbaugh did, when the ACA was passed, so they could have ‘Socialist’ Universal Health Care, which Costa Rica has?
  Rush DID move, like he said he would, didn’t he? Would Rush LIE?
JGC

Health Care Ruling’s Impact, Part VII:

Future Chief Justice Clarence Thomas is heard to mouth his first words from the Bench in over six years; court interpreters agree it looked like Justice Thomas was saying, “WHAT THE F*&K!”
josh

“our government is no longer limited!”

And you failed to notice the patriot act, the assassination act, the citizens united act, the electoral system, and continuous war without consent–acts against humanity? Are you blind and stupid?
- Kool Aid
  
  yes.. he was bsy drinking the kool aid
http://twitter.com/ylaenna Myra

I don’t understand why the health insurance mandate has some people in such a tizzy when we already have an auto insurance mandate in place.
http://twitter.com/cwooley89 Charles Wooley

I take issue with the guest who believes that this decision gives the government the right to impose a tax on anyone who does not buy broccoli. The fact is that at the end of the day if you need medical care and show up at the ER the government is required to foot the bill. There is no such requirement if you were to show up at the foodstore demanding broccoli. Plus the cost of this ER care is much higher than normal healthcare costs. Also when we pool together everyones risk into a pool it causes the overall cost of health insurance to go down due to the healthy people who are required to have coverage.

On another note, I heard a caller on the “Big Money in Political Campaigns” podcast lament the supreme court member’s life terms. But is is those very life terms that allowed the chief justice to break rank with the more conservative judges. There is not a chance in hell that he would have done this if he had to worry about running for re-election, as he would likely get massacred in a GOP primary.
http://twitter.com/cwooley89 Charles Wooley

It was a recording of John Landry not a guest on a show who made the broccoli comparison.
Dtwilson56

I’d like to hear your opinion on the following: Since no where is keeping health care costs down (a huge piece of the problem) being addressed, I’d like to hear how you’d react to”normal weight” discount if offered. (it’s like a good driver discount (incidentally, states can and do propose fees/penalties for NOT having car insurance–I don’t see much difference except it’s feds this time)). Maintaining a “normal” weight is a huge health risk eliminator (as is not smoking–which we make smokers pay a “tax” on their cigarettes). I would gladly submit to yearly “weight in” if it meant no co-pays or reduced healthcare payments. Seems to me that health care insurers win too–they get less risky health pool to balance out the 1 in 3 adults who are obese. BUT, maybe it’ll encourage the fat/obese to go for walks, eat healthy food (feed healthy food to their kids, more importantly) if there’s a big fat carrot for doing so. No “nanny state” because you’re being incentivized to eat and exercise and if you decide TV and the buffet is more important–you pay more because the insurers will have to pay out more.
http://twitter.com/TongoRad TongoRad

To the caller Frances, thank you for adding a human dimension to this discussion. Your call really touched me. I hope you get the health care you need and deserve. All the best.
Emitr

Back in the day, they hollered about the federal government taking away their liberties when it forced them to free their slaves. It’s the same old bellowing now. Never mind that people will be helped by this, like the slaves were when the blowhards hated Lincoln so much.
gslouch

I am baffled, absolutely baffled at those who oppose the president’s health care bill. This bill is going to help millions of people. The fact that you cant be refused coverage is a major, huge benefit. If you have listened to radio or read newspapers you ve had to have heard about sad cases where cancer patients have been denied coverage again and again, just totally ruining peoples’ lives. If you have listened carefully to the president you’ll know that the republican nonsense about “death panels” and socialized medicine,etc. is just that, nonsense! Of course both parties are politically motivated, but the fact that the Republicans would try to block something that will benefit most Americans is pitiful. Smilin’ mitch mcconnell stated that his primary goal is to oust the president not to help the American people. The Democrats need to seriously educate the people on the benefits of this health care bill. Maybe not perfect ,but a beginning.
D-gann

Gslouch, I am baffled, absolutely baffled that anyone can support legislation that no one was allowed time to read before voting on, about which the then Speaker of the House, Nancy Pelosi, said “We Have to Pass the Bill So You Can Find Out What’s In It”.
�
How can you on the left be so gullible as to believe in a benevolent government?
�
I honestly don’t understand how anyone can believe that more government intrusion into our lives in any area is a good thing.
�
We already know the bill was filled with deceptions from the beginning.
Healthcare cost have gone up,
Insurance costs have gone up,
It imposes a tax on some making less than $200,000.00 a year,
The enforcement of this bill alone is going to cost the taxpayers billions of dollars.
Not every American will receive healthcare. etc.
�
If the “penalty” under the mandate in Obamacare is not a tax, and President Obama and the left wing dems never intended it as a tax, then why was the IRS expanded from the very beginning, per the legislation, to collect the money?
Of course it is a tax and just the first of many more if this legislation is not overturned.
�
This is a bad, 100% left wing partisan, piece of legislation designed to move this nation towards 100% socialized, government controlled healthcare and needs to be repealed.
- Sam Walworth
  
  D-gann,
  
  I think you are for an abosulte baffled situation for a long long time as there are many many many Bills pass just like this.
  
  This one came into picture because this was on heated partisan lines there are hundreds more, on which both parties slap on each others wrist and get it passed.
  
  Both R and D parties do it on equal basis..
  
  I want a third party.. !!!!
  - Grandpadewey
    
    As a parent and a retired USN veteran, there are times when you have to step in and legislate behavior because the folks you’re dealing with are too immature or too ignorant to make a intelligent decision on their own. As much as I hate to say it, there are times when the better educated have to tell the ignorant what’s best for them.
Westernfan2

Mr. Romney,
�
Show me the actual piece of legislation you would propose to replace Obamacare, THEN we can discuss repealing Obamacare.�
You’ve mentioned several good ideas that would actually reduce the cost of healthcare- the ability to buy insurance across state lines for one- that I presume would be part of your alternative healthcare proposal. Here are two more:
Tort reform- I understand why punitive damages are sometimes assessed against a defendant, but why are they awarded to the plaintiff and their lawyers? If instead the court awarded the punitive damages to, for example, charitable organizations, the incentive to file spurious lawsuits would be diminished while preserving the deterrent effects of punitive damages for irresponsible behavior on the part of the defendant.
Healthcare costs- If uninsured, cash paying healthcare consumers were charged the same discounted prices that Insurance Companies have negotiated (or Medicare/Medicaid reimburses) with healthcare providers, out-of-pocket costs would be instantly reduced for many Americans. The U.S. Government cannot, and should not dictate pricing to private enterprise- but it would be perfectly reasonable to require pricing for common, routine healthcare services and procedures to be made available to consumers at every healthcare facility.
Slipstream

Thanks for another very valuable program. I am thankful that Justice Roberts decided to uphold the government’s right to legislate on this matter. I am no legal scholar, but I imagine that if, on top of Citizens United and the Florida recount, the Supreme Court had decided to overturn the Affordable Care Act on, let’s face it, purely political and not constitutional grounds, they could have been setting a dangerous precedent. There is no denying that the Supreme Court is a political institution, but it needs to be more than an extension of the wishes of political parties.

ONPOINT

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Sir Ken Robinson: Discovering Your Passions

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