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[Bauglir]

Being forced to buy car insurance is, admittedly, much less onerous because you can choose not to have a car. You can't exactly choose not to have health, barring suicide.

[MonkeyHead]

Which is why the NHS is a thing of beauty. Granted, my monthly National Insurance contributions are way more than my average monthly drain on the NHS, but in a roundabout way it paid for the medical treatment required at the birth of both my kids and will pay for any future treatment that I am bound to need at some point. We all pay it (made to pay it has a negative implication which doesnt feel right), and all get the benefit. Granted, some people choose to pay more for private care just like you guys do...

As a peron not from the US and outside to this whole sorry mess and lucky enough to have access to universal healthcare, the issue is more of a "Why is your healthcare run by private companies? Surely people shouldnt be allowed to make money out of suffering?" rather than a "Its wrong to force people to pay for a service that they dont need at this moment in time". I dont buy into the whole "free market" idea at all. If you need medical treatment, you arent going to not spend money on it if the price isnt right - you will pay if you value your health at all, so its easy for the market to artificially inflate prices IMHO.

[bulborbish]

Sure, health insurance in the United States is pretty ridiculous and prices are pretty high, but the best way to discourage that kind of behavior is with the free market.

Just a nitpik, Knight, but Health Care prices can only go down if more, not less, people are in the system. The rates that are charged to all customers go into the insurance company's coffers, which then distribute the service to insurance claimaints. The more people that you have paying into an insurance companies coffers, the easier it is to reduce rates, because less money overall is required to cover the minor increase in claimants.

The idea of the Insurance mandate was that if you had everyone paying into some insurance companies coffers, that prices would drop around the board. This is relying on the new additions of the currently uninsured (20 million is the last statistic that I recall), growing the coffer base.

Of course, all of this is mostly conjecture, and any real results probably won't be seen for a few years after implementation in 2014 (if, of course, it survives the court case).

FAKEEDIT: GRRR, Stop posting before me.

On a side note, a single player system (or a federal insurance plan) would see increased benefits, as now all people pay into one , huge, coffer. Of course, this is interpreted as socialist, so has a tough time seeing implementation in the US.

[nenjin]

And I sort of feel like part of the intention of this is to prop up the health insurance industry even more.

On the other hand, there are plenty of terrible stories about the quality of government-run healthcare elsewhere. So I think the appeal of private healthcare here in America is you can get quality service. At a premium...

The rates that are charged to all customers go into the insurance company's coffers, which then distribute the service to insurance claimaints. The more people that you have paying into an insurance companies coffers, the easier it is to reduce rates, because less money overall is required to cover the minor increase in claimants.

Because it's oh so historically accurate that these businesses pass their savings on to their customers rather than hoard it and even increase prices.

[Aqizzar]

That's part of why another aspect of the bill, as it's very large with many elements, is an attempt at price controlling.  Not by the prices themselves, but by instituting rather stiff "penalty taxes" on insurance companies that don't spend enough of their total yearly outlay on actual claims.  I.E., before the bill was passed, on average for a typical American health insurance company actual medical payments constituted about 35% of their total spending.  The new law would require it to be around 70% or 80% (I forget what exactly) or pay some serious taxes, basically making it illegal for a health insurance provider to be too profitable, or at least generates some new government revenue if they are (I believe it's automatically paid into the Medicare fund, but I could easily be wrong).

Of course, yes, in sum total it's basically a huge gift to the private insurance market.  As I heard it described, if Marget Thatcher had proposed the Affordable Care Act when Britain was setting up its national health system, she'd have been drummed out of office for something so "radically conservative".

[Knight of Fools]

Monkey Head, private Health Insurance is kind of like a community bank. Everyone who wants to participate is charged according to their insurance plan, any health issues that come up are deducted from the pool, and anything more than that goes to the company as profit. If too much is being removed by insurance claims, then the company raises its prices on everyone or lowers the percentage that it pays for claims. So if you participate in this, you get to help pay for everything from runny noses to heart transplants (Depending on the company's policies). Keep in mind that companies don't typically cover every health issue, and rarely foot the entire bill for anything (Again, subject to the company's policies).

The big reason this is such a big issue is the community/individual debate, which is kind of what we're having right now. The driving force behind health care is that it would, in theory, benefit everyone. However, this comes at the cost of individual freedom to choose. Whether or not I'm healthy and know to earn and use money wisely to pay for unexpected hospital visits, I still have to give money to benefit the rest of my community.

And that's the stick of the situation. Lots of people don't like being forced to pay directly for products they may or may not want or need. The need part is debatable in this case, of course, but there's also lots of people that need to quit smoking and drinking excessively. They're not only hurting themselves, they're putting other people in danger. There are bigger issues at hand than making sure everyone's paying for each other's hospital visits.

I don't disagree with what the health insurance law is trying to accomplish, here. I'm glad companies can't suddenly drop people when they get sick, now, and I like that companies actually have to spend their money on claims rather than more sexy secretaries. Other parts have just been done with a ham fisted approach that I find not cool.

Just a nitpik, Knight, but Health Care prices can only go down if more, not less, people are in the system. The rates that are charged to all customers go into the insurance company's coffers, which then distribute the service to insurance claimaints. The more people that you have paying into an insurance companies coffers, the easier it is to reduce rates, because less money overall is required to cover the minor increase in claimants.

More people in the system means more insurance claims, too, and it could mean larger ones pop up more often. Prices would probably stay about the same. I think the spending requirements Aqizzar mentioned, which are part of the law I agree with, are far more effective in lowering prices.

FAKEEDIT: GRRR, Stop posting before me.

I'd say the same thing, but I spend so much time thinking*, typing, and editing that I really don't have an excuse. Dang college classes are making me excessively verbose and opinionated.

*Okay, not really.

[Aqizzar]

I don't disagree with what the health insurance law is trying to accomplish, here. I'm glad companies can't suddenly drop people when they get sick, now, and I like that companies actually have to spend their money on claims rather than more sexy secretaries. Other parts have just been done with a ham fisted approach that I find not cool.

This is a key issue.  The Affordable Care Act (don't forget, that's its actual title) does a ton of different things, all trying to "fix" the problem of considerable numbers of people being uninsured alongside the high cost of healthcare.  Many of which have nothing intrinsically to do with each other beyond being in one bill.  So if you say something like, I want the "family coverage extends to 26" part and the "can't be denied for pre-existing conditions" law but I don't want the "I have to buy a product at whatever price the market gives me" part, it gets complicated.

The Supreme Court most certainly has the power and precedent to strike down individual parts of a law without striking down the whole "law" (read: bill), it's happened plenty of times.  But you've also got Justice Scalia saying, man you can't expect us to read this whole thing, I didn't become a Supreme Court Justice to sit around reading laws all day, so if the mandate is unconstitutional we should throw the whole thing out.

Every single word that comes out of the decision is going be scrutinized to Hell and back.

[MonkeyHead]

Knight, I get what one is. Its no different to how the NHS runs and is funded, other than EVERYONE is expected to pay into the NHS as EVERYONE gets the benefit. There is no maybe, or choice issues. The difference is that it doesnt profit like a private company will. A private company will raise prices/premiums to remain profitable if circumstances dictate. Thre is less incentive for them to lower prices, especially in the field of healthcare, as most people will not choose to do without. Alas, I feel that as a citizen of the UK and not the USA, I cant really get my head around the train of thought regarding your healthcare system - I have been "brainwashed" for want of a better word by our system!

[Mr. Palau]

Monkey Head, private Health Insurance is kind of like a community bank. Everyone who wants to participate is charged according to their insurance plan, any health issues that come up are deducted from the pool, and anything more than that goes to the company as profit. If too much is being removed by insurance claims, then the company raises its prices on everyone or lowers the percentage that it pays for claims. So if you participate in this, you get to help pay for everything from runny noses to heart transplants (Depending on the company's policies). Keep in mind that companies don't typically cover every health issue, and rarely foot the entire bill for anything (Again, subject to the company's policies).

The big reason this is such a big issue is the community/individual debate, which is kind of what we're having right now. The driving force behind health care is that it would, in theory, benefit everyone. However, this comes at the cost of individual freedom to choose. Whether or not I'm healthy and know to earn and use money wisely to pay for unexpected hospital visits, I still have to give money to benefit the rest of my community.

And that's the stick of the situation. Lots of people don't like being forced to pay directly for products they may or may not want or need. The need part is debatable in this case, of course, but there's also lots of people that need to quit smoking and drinking excessively. They're not only hurting themselves, they're putting other people in danger. There are bigger issues at hand than making sure everyone's paying for each other's hospital visits.

I don't disagree with what the health insurance law is trying to accomplish, here. I'm glad companies can't suddenly drop people when they get sick, now, and I like that companies actually have to spend their money on claims rather than more sexy secretaries. Other parts have just been done with a ham fisted approach that I find not cool.

Just a nitpik, Knight, but Health Care prices can only go down if more, not less, people are in the system. The rates that are charged to all customers go into the insurance company's coffers, which then distribute the service to insurance claimaints. The more people that you have paying into an insurance companies coffers, the easier it is to reduce rates, because less money overall is required to cover the minor increase in claimants.

More people in the system means more insurance claims, too, and it could mean larger ones pop up more often. Prices would probably stay about the same. I think the spending requirements Aqizzar mentioned, which are part of the law I agree with, are far more effective in lowering prices.

FAKEEDIT: GRRR, Stop posting before me.

I'd say the same thing, but I spend so much time thinking*, typing, and editing that I really don't have an excuse. Dang college classes are making me excessively verbose and opinionated.

*Okay, not really.

Well actually knight the way a insurance company pays for anything is they take your money, and then invest it in other things to earn a profit, part of which goes to making the amount of capital they have on hand larger and part of which goes to their profit as a company. So the company takes your 100 bucks, adds it to everyone else's  money, buys stocks or bonds or other investment vehicles, and then they use that to accumulate capital in the form of stocks and bonds and other things, which they will sell when you get sick and need care.

There are many horror stories of people who couldn't afford to pay sudden healthcare bills because they didn't have insurance, but as you mentioned you are healthy. The reason this goes beyond your individual freedom is that when you go to the hospital and are unable to pay it gets passed on to everyone else. Sure you could pay, but many poor people go to the emergency room for basic care, because they have to help you due to laws passed by the government and the Hippocratic Oath, both of which say a doctor must treat patients who can not pay, so the doctors charge other people more.

Now if your healthy self was to join the insurance market, you would have to pay into the collective pool of capital that is used to finance other people's health care expenditures. Under ObamaCare the poor and unhealthy uninsured will also be included in the market, with the poor receiving subsidies, this will absorb a substantial proportion of the increased profits from the increased pool of capital now available to insurance companies, along with things like covering pre-existing conditions. Ultimately the increased profits will exceed the increased costs from new insurance claimants, because most uninsured people are young healthy people like you and me who think they will never need it, (although I am still young enough to be covered under my parent's plan), so they will be able to decrease the price of insurance. 

ObamaCare also includes things like cost controls for Medicaid, estimated to save 10% in ten years, and costs controls for healthcare in general in order to reduce what has been on average a 8% inflation rate in the healthcare market. It also ensures that the increased savings from the bill will go to customers by limiting the amount of profits insurance companies can earn, as Aquizzar mentioned.

Also, as Aquizzar mentioned, the individual mandate is what pays for many of the increased insurance coverage of the bill because if healthy people don't pay up then the company only covers sickly people, increasing the risk to the company and hence the cost to the customers, assuming profits are static. Without the mandate the companies just couldn't afford to lower their prices without being lynched by their shareholders.

I'm actually not in favor of a health insurance market, I believe in health savings accounts like what Singapore has, but if you have to have a private health insurance market than this is one of the best options. Of course you can questions whether there should be a public or private market but that's another question.

[Knight of Fools]

The main issue I have with the "it'll save money" claim is that the government is involved, and it's historically terrible with money. Most of the people that will be receiving health care from the government for free won't be paying taxes, so the cost of their insurance goes to the tax payers. It would probably be cheaper to just pay up front for the medical costs, rather than passing the money through government insurance and then medical care. More than a few dollars are going to get shaved off in the process.

I'd prefer a medical savings account, too, but that's more of a personal thing. It would likely kill the health care market for those that can afford to save, which is the main issue here. Those that would have health insurance would pay ridiculous premiums because the only ones with health insurance would be those who were sick and/or poor.

On the other hand, I'd take the medical savings account if it meant I could opt out of mandatory health insurance. I'm already saving money for just-in-case scenarios, so it wouldn't be a huge loss. More choice is better than no choice.

The Supreme Court most certainly has the power and precedent to strike down individual parts of a law without striking down the whole "law" (read: bill), it's happened plenty of times.  But you've also got Justice Scalia saying, man you can't expect us to read this whole thing, I didn't become a Supreme Court Justice to sit around reading laws all day, so if the mandate is unconstitutional we should throw the whole thing out.

I guess that's a consequence of putting all the eggs into one basket.

[MetalSlimeHunt]

Now, you could be advocating that we just let sick people who can't pay just, yanno', die off or be permanently crippled or whatev' but medical practitioners are supposed to swear that little oath (that we really want them swearing) that says they have to help those that come to them.

Medical practitioners are not required to take the Hippocratic Oath and it has no legal bearing even if they do.

[Dutchling]

Now, you could be advocating that we just let sick people who can't pay just, yanno', die off or be permanently crippled or whatev' but medical practitioners are supposed to swear that little oath (that we really want them swearing) that says they have to help those that come to them.

Medical practitioners are not required to take the Hippocratic Oath and it has no legal bearing even if they do.

You don't have the right to get medical care in the US? Aren't there like international laws about that?

Anyway, isn't the US the only western country without a decent medical/insurance system by now? I'm by no means an expert but that is just the impression I get.

[MetalSlimeHunt]

You don't have the right to get medical care in the US?

That wasn't actually what I meant by that; just that the Hippocratic Oath is only a ceremony. Hospitals do have to treat you if you show up in the ER with a life-threatening condition, but otherwise no.

Aren't there like international laws about that?

Even if there were no nation follows international laws.

[Dutchling]

Frumples post seemed to indicate that US dont actually have to do that. Guess it's not that bad over there:p

[Bauglir]

Doctors aren't required to take the oath, they are legally required to treat people with a life-threatening condition.

The main issue I have with the "it'll save money" claim is that the government is involved, and it's historically terrible with money.

I am skeptical of this, to the extent that I don't believe the government is that much worse than anyone else. They're just bad with it in different ways than, say, a large corporation.

Also, you're still overlooking the whole prophylaxis thing. If you catch a problem before it's a major problem, it helps a lot with the cost as well as actually fixing the problem, and there are a lot of people who won't go to the hospital unless they're basically dying because they either don't have the money (are uninsured) or aren't sure they'll be able to get their insurance provider to pay the claim or are afraid it'll drive up premiums (if they aren't on an employer plan, in that last case). It's not hard for me to believe that that, combined with eliminating the necessity for the insurance plan to be profitable to the provider, would more than offset the cost of whatever bureaucracy the government adds.

Further, it doesn't exactly kill the personal savings idea. If there's one thing that's true, it's that you can always get the wealthier people around to shell out for a more expensive service by making it cost more and implying it's of higher quality. Not every doctor would be obligated to work for a public hospital, after all, so a market would still exist. It would just have to compete with a public standard.

Ultimately, though it seems to me a question of maintaining a selfish ideal (one that isn't that bad, in a vacuum) by asking the unfortunate to suffer and die needlessly. Preserving your right to choose whether to have access to affordable health care (which is ultimately what this is all about) isn't just about your choice. You're also choosing for the people who don't have access to a public provider. There's no solution here that really preserves a "right to choose", but there could be one that prevents a whole lot of pointless pain at the expense of a few dozen dollars a month.

Of course, I started rambling on about a topic that isn't in the bill. Actual public healthcare isn't provided, and so this is purely a theoretical post, not one pertinent to the specific court case.