Place your bets: Supreme Court ruling on PPACA?

[Kolonial]

Strollen, if this is the counter-argument, I'm changing my prediction to 9-0 in favor of the law.

[Strollen]

Well, we wouldn't want to benefit the unlucky.

I have no problems spending a thousand or two a year to make sure the unlucky folks get medical treatment, knowing that I could be one of the unlucky people.

The assertions is that unlike auto insurance where many people go there whole live with a serious accident, everybody needs health insurance or expensive health care. This isn't true for young and middle age because a small percentage of the population consumes a huge portion of health care costs.

In the same way that average drivers would save money over their life with a high deductible and paying for fenders benders out of their own pocket. The same thing is true for most health care consumers, if we got higher wages but no insurance and then paid for medical care out of pocket (e.g. paid a few hundred for annual physical) most people would come out financial better. Obviously the unlucky person who gets a cancer or brain tumor goes broke.

I personally like to see us move to health care system, were preventative care was inexpensive, and catastrophic diseases were covered, but routine health care (Viagra, birth control, cholesterol drugs, pregnancies, broken arms) was paid out of pocket. Of course this has no chance of happening.

[Kolonial]

Strollen, we don't insure people just for serious accidents. You just described your own family as one that made frequent use of healthcare facilities and professionals and used insurance to cover those costs.

I'll tell you what: if you're lucky enough to die young having never once visited a doctor or hospital, your family can have a partial refund. For the other 99.9999%, pay up. I should warn you before you take this deal: you were born in a hospital and spent at least the first two days of your life there. Want to see what your parents' bill would have been without insurance?

[Strollen]

Strollen, if this is the counter-argument, I'm changing my prediction to 9-0 in favor of the law.

Care to bet?

[Kolonial]

Care to bet?

Is that the counter-argument you expect to be presented? "Some people get lucky and die without needing a doctor first?" I think they'll come up with something better than that.

But yes, if that's their assertion, then I will take the bet.

[Strollen]

Strollen, we don't insure people just for serious accidents. You just described your own family as one that made frequent use of healthcare facilities and professionals and used insurance to cover those costs.

I'll tell you what: if you're lucky enough to die young having never once visited a doctor or hospital, your family can have a partial refund. For the other 99.9999%, pay up. I should warn you before you take this deal: you were born in a hospital and spent at least the first two days of your life there. Want to see what your parents' bill would have been without insurance?

No I just described my family as the opposite

I can think of only one male member of my family who had any need of expensive medical care prior to turning 65.

Meaning my dad, both grandparents, nephew, and one brother-in-law never spent more than a day in the hospital before being covered by Medicare. One Brother In law has but this is mostly cause he rides motorcycles and crashes. Interestingly enough when looking through my Mom's saving deposit box recently I found the hospital bill, with my birth certificate. The bill was $263 less than a month insurance for me today. Since maternity care was not a covered benefit at the time my dad paid for it, 48% of medical cost were paid out of pocket back in 1960 vs 12% now.

Even today pregnancies run 10-20K , a few months salary, or a couple years of insurance premium for a family. FYI, this fits nicely with this data showing the a 55x increase in medical cost from 1960 to 2008. Now this is a serious chunk of change but only small fraction of the cost of raising a kid over a life time.

To be clear I was not making a larger point about the constitutional arguments about ObamaCare. The commerce clause is complex and I doubt any of the argument this thread have made will make it to the Supreme Courts chamber over the next 3 days. Hell they are going to spend the 1st day arguing if the court can rule on the Mandate before it takes affect, some 1870 law or such. This is something no one on the thread has even mentioned.

I am simply disagreeing with you that health insurance is unique because unlike auto insurance everybody uses their health insurance. I think their are more similarities than differences. Some people have policies with very low deductible to protect against every fender bender, other like myself never take collision insurance. I know many retired, or self-employed people who only have catastrophic medical insurance. They pay everything until they reach a very high deductible $5,000 or $10,000. They very likely will never file a claim (Yes they benefit from negotiated rates but that is function of our completely screwed up system.) The way they figure it they save $400-$500/month vs a regular policy and use an HSA which makes up for the high deductible. I don't even know if maternity care is covered on these plans probably not.

ObamaCare mandate everybody has collision insurance with a low deductible, this maybe a good thing, but I have my doubts. By June the Supreme Court will rule if is constitutional.

As for the bet, I simply wanted to wager on the 9-0 vote upholding the law. We don't even need wager money, the loser just needs add "I'm an idiot and Strollen's a genius"or vice versa at the end of each post for a month.

[JeffL]

The first day the SC will be ruling on whether they should be hearing the case at all at this point, since there have been no fines issued yet (and won't be for a while.) Since I haven't heard much discussion on this ruling, I assume the "experts" don't believe they'll postpone the ruling.

As for the Commerce Clause being complex, the problem is that it is very, very simple:

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes

It was written to cover, primarily, naval trade and interactions with the Indians in the U.S.

Interpretation is certainly complex, of course (thus this thread and so many other applications that are argued.) All revolving around what it means when you say that Congress has the power to regulate commerce between the several states. Clearly, the authors couldn't have conceived of commerce between "the several states" to have become what it is today (and I know, you can say that about more than the Commerce Clause.)

FWIW, I'm still on the second cup of coffee this morning.

[Damion Schubert]

I can think of only one male member of my family who had any need of expensive medical care prior to turning 65. At which point they are covered by Medicare, which is a separate discussion from ObamaCare. The rest of us paid insurance, or were covered by employer insurance, or the case of my nephew gone with out. Yes my family has been lucky, but the need for health insurance for people under 65 is far from universal, just like most people would be better off without auto insurance. Health insurance benefits those who are unlucky, and/or who's behavior result in a bad health.

Your thinking is exactly why we need universal health care. See, the odds that something will go catastrophically wrong is low enough, especially if you are young, that economically many people choose to 'play the odds', and go without health insurance, relying on the fact that the law will compel the hospital to provide you care in some emergency instances. As insurance costs go up, more people choose to play these odds, figuring 'hey, I never get seriously sick', which means that the pool of people in the insurance pool become unhealthier, which makes health care costs go up again in a horrible death spiral.

So congrats! You're part of the problem!

Also you talk about about how in California, you can opt out of car insurance by putting up a $10K bond. Well, in Obamacare, you can opt out of health insurance if you pay a relatively small penalty (in most cases, the penalty is cheaper than health care, and in most cases, way less than $10K).

In terms of the general argument, I'm still not sure how a competent lawyer couldn't argue that Obamacare is effectively a tax increase (the penalty for noncompliance) that the consumer can't bypass with economic activity (purchasing health care somehow). When looked at this way, Obamacare's mandate is pretty much identical to a billion other elements found in the tax code designed to encourage personal or corporate spending behavior (tax credits for purchasing electric cars comes to mind).

[JeffL]

Since the fine is less than the health care insurance, has anyone done any analysis of whether the mandate will actually accomplish its goal?

[Jason McCullough]

I have no problems spending a thousand or two a year to make sure the unlucky folks get medical treatment, knowing that I could be one of the unlucky people.

I'd love to see the numbers assumptions you're operating under here where you'd save a lot of money by only paying to cover "the unlucky" instead of "people who deserved it."

Viagra, birth control, cholesterol drugs, pregnancies, broken arms

Given your set of examples, I think you're operating under same strange assumptions about costs. A broken arm visit to the emergency room costs around $2,000. Note most people have auto insurance deductibles of $500 or $1000. Pregnancies are even worse, at like $10,000 to $20,000; basically no one can pay that given 9 months notice, so you're implicitly suggesting that everyone needs to finance their their pregnancies like a car.

[JeffL]

Given your set of examples, I think you're operating under same strange assumptions about costs. A broken arm visit to the emergency room costs around $2,000. Note most people have auto insurance deductibles of $500 or $1000.

For people with less expensive insurance, a $2000 trip to the emergency room would come out of their pocket and not the insurance company's pocket. The insurance we bought my daughter when she was in between living at home and in school pretty much covered some very basic doctor's visits and provided catastrophic coverage, but if she had a broken arm and a $2000 emergency room visit, that would have come out of our pocket.

I'm still not convinced that the Mandate is going to work the way it would have to in order to accomplish its needs, as I am guessing the kind of people who decide to gamble and go without insurance are the same people who are going to gamble and risk the fine, especially when that may be the cost effective approach due to the size of the fine.

[Papageno]

The rather small size of the fine for not having nor purchasing adequate insurance is definitely troubling. On the other hand, what with the subsidies I think that even most younger/healthier people who'd have to use the exchanges would rather play it safe than be stuck waiting for the next open enrollment period and have to pay a big chunk out of pocket in the case of an uninsured E-room visit due to wiping out on your bike/falling off your roof/whatever, or worse, being diagnosed out of the blue with some horrible cancer like the character in the movie 50/50. I know I would have if I'd had the option when I was uninsured during a good chunk of my 20's and into my early 30's.

We've got to remember that the subsidies (up to 400% of the official poverty line) will factor into the decision.

[Kolonial]

Don't forget part of the bill includes bring able to stay on your parents' insurance until 26, which goes a long way toward covering those young, healthy years you refer to. Most people should be insured by their employer by then.

[Papageno]

Don't forget part of the bill includes bring able to stay on your parents' insurance until 26, which goes a long way toward covering those young, healthy years you refer to. Most people should be insured by their employer by then.

This is true too (provided of course your parent(s) want to keep you on it and keep paying your premium, and actually have work-provided/subsidized insurance).

Unfortunately a lot of people in their later twenties in our current system aren't in the kinds of jobs that have much in the way of employer-provided insurance.

[Strollen]

I'd love to see the numbers assumptions you're operating under here where you'd save a lot of money by only paying to cover "the unlucky" instead of "people who deserved it."



Given your set of examples, I think you're operating under same strange assumptions about costs. A broken arm visit to the emergency room costs around $2,000. Note most people have auto insurance deductibles of $500 or $1000. Pregnancies are even worse, at like $10,000 to $20,000; basically no one can pay that given 9 months notice, so you're implicitly suggesting that everyone needs to finance their their pregnancies like a car.

First of all there of plenty of people who can and have saved $10,000, it is less than average down payment for a house and majority of people have those. Perhaps we shouldn't encourage people without financial means to have children.

In most places you can get catastrophic insurance for ~$100/month although obviously this varies a lot by age and location. (For the record I favor universal catastrophic coverage paid for by taxpayers). The delta between $100 and typical insurance cost is considerable. If this delta was was paid to employees in the form of higher wages the saving from 3-5
years of premium would pay for the delivery. More importantly if this was an out of pocket expense, it would encourage consumer to shop around and perhaps use less expense procedures like a registered nurse midwife.

One of the biggest problems with health care in the US is that since the out of pocket expensive have dropped from 1/2 in 1960 to 12% today there is very little incentive for people to shop

[Hugin]

First of all there of plenty of people who can and have saved $10,000

Average household savings is less than half that.

it is less than average down payment for a house

This is almost certainly wrong, given every stat I can find about average home prices in the US.

and majority of people have those.

I'm fairly certain a majority of adults in the US do not have own a house.

[maxle]

One of the biggest problems with health care in the US is that since the out of pocket expensive have dropped from 1/2 in 1960 to 12% today there is very little incentive for people to shop

That's an easy problem to solve. You copy Singapore and mandate prices be posted openly for all to see. As is, you can ask a doctor what a procedure will cost and they'll have no fucking clue.

[djotefsoup]

For people with less expensive insurance, a $2000 trip to the emergency room would come out of their pocket and not the insurance company's pocket.

Not meaning to derail this but holy shit that turns out to be what you would actually pay (google says to $2500us for non surgical treatment?). When I broke my radius and scaphoid everything I got for it in australia was free. But - when I actually broke them I was in Nepal, and being charged rip-the-living-shit-out-of-tourists-with-money rates, with an american radiologist and a local prof doc orthopaedic specialist - who even the australian people back here who handled recasting it said had done an amazing job on it.

The total cost was $300US including medication. Also they will sell you pure codeine.

Sorry to interject but I am sure pretty much every other non-US resident is just fucking agog at the shit that goes on there (and mild amusement to complete horror at the kinds of things wheeled out to defend the current system) and occasionally the power of WTF compels one to post.

[JeffL]

Not meaning to derail this but holy shit that turns out to be what you would actually pay (google says to $2500us for non surgical treatment?). When I broke my radius and scaphoid everything I got for it in australia was free. But - when I actually broke them I was in Nepal, and being charged rip-the-living-shit-out-of-tourists-with-money rates, with an american radiologist and a local prof doc orthopaedic specialist - who even the australian people back here who handled recasting it said had done an amazing job on it.

The total cost was $300US including medication. Also they will sell you pure codeine.

Sorry to interject but I am sure pretty much every other non-US resident is just fucking agog at the shit that goes on there (and mild amusement to complete horror at the kinds of things wheeled out to defend the current system) and occasionally the power of WTF compels one to post.

Yeah, you should see what the itemized lists look like. Even routine things like bandages and ibuprofen cost a ton more in the hospital than they would if you just went to the store and bought them. Heck, $300 won't cover the doctor who peeks in through the curtain in the emergency room and says "Hmmm - yep, looks broken. We'll have someone X-ray that for you. Bye."

[Damion Schubert]

Since the fine is less than the health care insurance, has anyone done any analysis of whether the mandate will actually accomplish its goal?

It's something that Ezra Klein (who is otherwise quite pro-ACA) has mentioned frequently, though I don't see an analysis. Example: "The irony of the mandate is that it's been presented as a terribly onerous tax on decent, hardworking people who don't want to purchase insurance. In reality, it's the best deal in the bill: A cynical consumer would be smart to pay the modest penalty rather than pay thousands of dollars a year for insurance. In the current system, that's a bad idea because insurers won't let them buy insurance if they get sick later. In the reformed system, there's no consequence for that behavior. You could pay the penalty for five years and then buy insurance the day you felt a lump."

Reading through Ezra's backlog of blog posts and articles over the last two years is an excellent way to get up to speed on health care, and the ACA in particular.

[russellmz00]

Since the fine is less than the health care insurance, has anyone done any analysis of whether the mandate will actually accomplish its goal?

doesn't massachusetts show it works pretty well? someone even thought about the children.

http://www.mass.gov/eohhs/docs/dhcfp...rt-12-2010.pdf

98.1% of Massachusetts residents had health insurance coverage in 2010, an uninsured rate of just 1.9% at the time of the survey. This corresponds to approximately 120,000 people.

The uninsured rate was higher among Massachusetts residents in fair or poor health than among those in better health (2.8% versus 1.8%) in 2010.

As in 2009, virtually all children in Massachusetts were insured in 2010 (99.8% versus 98.1%). That change was statistically significant, as were the changes reported for lower-income children.

the federal penalty rate starts off small but get larger over time (2.5% of income of $695, whichever is larger).

[Strollen]

Average household savings is less than half that.




This is almost certainly wrong, given every stat I can find about average home prices in the US.




I'm fairly certain a majority of adults in the US do not have own a house.

You are 0 for 3 here. Try using Google. Home ownership is 66% down from a peak of 70%. Frankly, I am surprise that anybody who has paid attention to the economy wouldn't have a basic grasp of homeownership statistic in the country.

Median price of homes in the US is 220K average is around 280K. In order to buy a home you need a practical minimum of 5% down. 5% * $220,0000=$11,000, and a fair more common down payment is 20% so 2/3 of households have historical come up with >$10K and many have come up with 40K. Therefore they could do the same to have a baby.


As far average household saving link please.

[Exodor]

Not meaning to derail this but holy shit that turns out to be what you would actually pay (google says to $2500us for non surgical treatment?).

When my wife spent two weeks in the hospital last year and it came time to get the bill the total was ~$74,000. If she had a plan without caps on out of pocket expenses our share would have been ~$15,000. I had to put $2k on my credit card just to get her out of the hospital.

About a month before her final hospital stay her employer tried to terminate her job which would left her uninsured. If she was single that would have put her in the position of either facing another $75,000 bill or not getting treatment.

Our current system is fucked beyond belief.

[Hugin]

You are 0 for 3 here. Try using Google. Home ownership is 66% down from a peak of 70%. Frankly, I am surprise that anybody who has paid attention to the economy wouldn't have a basic grasp of homeownership statistic in the country.

That not what "Home Ownership" means in the context of you claiming the "majority of people have houses." The statistic you're citing is a measure of how many housing units are occupied by their owner.

But that includes multi-unit houses with additional tenants who do not own, and houses with other adults living in them who do not own, including, obviously, adults living with their parents who cannot yet get their own house or, in a bad economy, have moved back into their parents house.

Median price of homes in the US is 220K average is around 280K. In order to buy a home you need a practical minimum of 5% down. 5% * $220,0000=$11,000, and a fair more common down payment is 20% so 2/3 of households have historical come up with >$10K and many have come up with 40K. Therefore they could do the same to have a baby.

I misunderstood the point you were getting at here. Apologies.

As far average household saving link please.

According to the Bureau of Economic Analysis, the average household savings rate is less that 5 percent. Something like 4.7 percent. This roughly matches the calculations of the Federal Reserve. Median household income in the US is about 31K (using median here because massive income disparities at the top end distort the average).

There's also this: http://papers.nber.org/papers/w17072 (full disclosure, I work there and know two of the researchers involved in the study).

[IainC]

My wife got bronchitis on a recent trip back home. She didn't have travel insurance because she holds a US passport and you can't get travel insurance to your own country and obviously didn't have US medical insurance. Two clinic visits and a round of antibiotics cost us $1000. Because of the cost she put off going to see the doctor again until the bronchitis had turned into pneumonia at which point we added another $3000 to that bill. The doctor wanted to admit her to the ICU but we had to refuse as we simply couldn't afford it.

Of course we should have had to pay for treatment but the cost for something as routine as a chest infection was simply insane.

[Two Sheds]

Maybe you should have saved for bronchitis and pneumonia like you would for a house down-payment, IainC.

[Jason McCullough]

First of all there of plenty of people who can and have saved $10,000, it is less than average down payment for a house and majority of people have those

Please provide evidence on how many households have 1) $10,000 in liquid reserves.

One of the biggest problems with health care in the US is that since the out of pocket expensive have dropped from 1/2 in 1960 to 12% today there is very little incentive for people to shop

Please provide evidence that services that would be covered by out of pockets expenses are 2) a significant component of health care spending, 3) a significant driver of health care cost increases, and 4) a model or historical evidence for something like health care where prince incentives to end users result in significant reductions in costs without offsetting reductions in health.

[Kolonial]

I know many retired, or self-employed people who only have catastrophic medical insurance. They pay everything until they reach a very high deductible $5,000 or $10,000. They very likely will never file a claim (Yes they benefit from negotiated rates but that is function of our completely screwed up system.) The way they figure it they save $400-$500/month vs a regular policy and use an HSA which makes up for the high deductible. I don't even know if maternity care is covered on these plans probably not.

Again, the point isn't that some people may never make large claims against their insurance. The point is that they're going to use the healthcare system (and already have). Just because you live in a fantasy land where people can save $10,000 "over a couple of months" doesn't mean the rest of us do.

As for the bet, I simply wanted to wager on the 9-0 vote upholding the law. We don't even need wager money, the loser just needs add "I'm an idiot and Strollen's a genius"or vice versa at the end of each post for a month.

As long as we're moving goalposts, let me say this: if an alien inhabits the body of Clarence Thomas during deliberations, it's difficult to say which way he'll vote. Otherwise, I think we all know it will never be a unanimous decision.

[Timex]

Again, the point isn't that some people may never make large claims against their insurance. The point is that they're going to use the healthcare system (and already have). Just because you live in a fantasy land where people can save $10,000 "over a couple of months" doesn't mean the rest of us do.

In most of those peoples' situations, they never have to file a claim. For most people, you never actually need serious health insurance. You don't have catastrophic problems.

So, for those people, having a 10k deductible actually saves them money, because its reducing the monthly payments they have to make.

[Houngan]

In most of those peoples' situations, they never have to file a claim. For most people, you never actually need serious health insurance. You don't have catastrophic problems.

Er, cite? Anecdotally, I find that hard to believe.