ADDED: I'm reading the opinion. Judge Roger Vinson rejects the argument that the individual mandate is actually a tax and therefore that the Anti-Injunction Act is an obstacle to the lawsuit. Key point:
[I]t is inarguably clear that Congress did not intend for the exaction to be regarded as a tax...Congress didn't call it a tax and "the defendants are wrong to contend that what Congress called it 'doesn’t matter.'"
Congress did not state that it was acting under its taxing authority, and, in fact, it treated the penalty differently than traditional taxes.The failure to call it a tax was especially important because the act was so controversial:
One could reasonably infer that Congress proceeded as it did specifically because it did not want the penalty to be “scrutinized” as a $4 billion annual tax increase, and it did not want at that time to be “held accountable for taxes that they imposed.” In other words, to the extent that the defendants are correct and the penalty was intended to be a tax, it seems likely that the members of Congress merely called it a penalty and did not describe it as revenue-generating to try and insulate themselves from the potential electoral ramifications of their votes.Because it is a penalty and not a tax, the act cannot be upheld with the taxing power. The question must be the scope of the Commerce Power.
AND: Judge Vinson upheld the standing of the individual plaintiffs and the state plaintiffs, and he held that the claims were ripe. Even though the mandate doesn't go into effect until 2014, it is "certainly impending" and "responsible individuals, businesses, and states will have to start making plans now or very shortly to comply with the Act’s various mandates."
Finally, the judge considered the motion to dismiss for failure to state a claim. He dismissed some of the claims relating to state sovereignty, and I won't bore you by attempting to paraphrase this part. If you don't know the law in this area, you'd be better off trying to read pages 41-58 of the opinion. So let me confine myself to the individual mandate. Judge Vinson rejects the due process argument, because the scrutiny in this area is minimal and Congress had a rational basis for the mandate. But the Commerce Clause challenge survived.
At this stage in the litigation, this is not even a close call. I have read and am familiar with all the pertinent Commerce Clause cases... This case law is instructive, but ultimately inconclusive because the Commerce Clause and Necessary and Proper Clause have never been applied in such a manner before.... There are several obvious ways in which Heart of Atlanta and Wickard differ markedly from this case... Those cases... involved activities in which the plaintiffs had chosen to engage. All Congress was doing was saying that if you choose to engage in the activity of operating a motel or growing wheat, you are engaging in interstate commerce and subject to federal authority....
... The individual mandate applies across the board. People have no choice and there is no way to avoid it. Those who fall under the individual mandate either comply with it, or they are penalized. It is not based on an activity that they make the choice to undertake. Rather, it is based solely on citizenship and on being alive....
Posts
139 comments:
That was damned nice of him.
Then again, a Reagan appointee.
Term limits for Federal judges are looking better than ever.
Penalties are for bad people. Does Obama think that we are all bad people? A variation of the famous Jack Benney joke needs to be inserted into the opinion: "Your money or your penalty paid in money says the armed robber." But taxes are only for governing a free people, and you jerks are no longer free in Obamaland.
This judge is gay! Ooops, wrong case.
What a novel idea.. to call things by their given name?
Yes we CAN!!
The judge got it exactly right: Congress went out of its way when writing the legislation to declare that it WAS NOT a tax.
Now that they have to defend it, they say OF COURSE it's a tax.
They want to have it both ways, and all the judge is saying is: you had to make a choice - either get hammered for raising taxes but get your program through under the taxing authority of the federal government, or make it a penalty and make the claim to voters that you DIDN'T raise taxes.
You took the coward's way out thinking you could avoid the inevitable electoral thumping by calling it a "penalty" instead.
So don't come crying to the judge now that it's a tax unless you're willing to start running ads saying that you've been lying to entire country for the last year and a half about whether or not it's a tax.
Garage isn't ready to admit that every Democrat who voted for this thing, up to and including Obama, is a flat-out liar, but he wants the judge to give them credit for the lie without the blame.
Sorry...it doesn't work that way, garage (and the other Lefty liars who have been claiming all along Obamacare didn't raise taxes).
You made your bed. Lie in it.
And enjoy the thumping you're going to take at the polls anyway. The American people understand that whether it's a penalty or a tax is irrelevant: the Democrats are stealing their money, and they've had enough.
Because it is a penalty and not a tax, the act cannot be upheld with the taxing power.
Has anyone ever took a close look at their phone bill?
Federal:
Federal tax?
Subscriber Line Charge?
Federal USF Recovery Charge?
LNP Surcharge-Acc Ln?
FCA Long Distance-Federal USF Surcharge?
Who gives a fuck what it's called, it's an attempt to take money out of people's pockets!
AllenS:
Yeah I love when libs dream up new taxes that will be paid by cable, phone companies and banks, etc
As if the consumer won't get socked with the new tax.
If congress has power over your health care simply because you live and breath and go to doctors, then what doesn't congress have power over?
Your recreation of choice has accident statistics, and that is related to your health care.
Your sexual activities have disease statistics, and that is related to your health care.
Your drinking, smoking, eating, physical activity all have implications to your health, and therefore to the government's health care.
Same for your career choice.
Want to be a football player, that has an increased incidence of arthritis in later years, and that is now congresses concern.
How can you even argue that this is within congresses power under the commerce clause, when to so argue means that congress has all power and the commerce clause is moot.
And enjoy the thumping you're going to take at the polls anyway. The American people understand that whether it's a penalty or a tax is irrelevant: the Democrats are stealing their money, and they've had enough.
Hey the only guy I sent money too, and the only race I really care about is Feingold. Obama will look pretty moderate compared to GOP loons in the House, and just give him something to run on in 2012 . I honestly hope a ton of shitty Democrats lose, but I'm not even convinced the GOP will regain control of anything to begin with.
If taxes aren't being imposed in the bill, then why is the IRS the department of note that will be required to collect them? Are they going to be called fees? Also, what about the penalty for not buying Captain Kick-Ass Care? Is there no end to the leftardism in this country? Make it stop already.
Can the lawyer types confirm my reading of this? It looks like he's allowing folks to take a shot at the mandate, but he's not letting them take a shot at the specific health insurance policy changes that are mandated by the new law, but he is letting them take shots at the part of the law that makes states put more folks into Medicare if they want to continue to receive Medicare dollars from the Feds.
So, If the judge eventually agrees w/ the parts he let through, the health care changes will go forward sans a mandate, and sans states being force to expand Medicare?
Now tell me how I'm completely wrong. Or, w/ luck, only ninety percent wrong.
"Penalties are for bad people. Does Obama think that we are all bad people?"
Not all of us. Just the ones who are standing in his way.
How many lawyers can dance on the head of a pin?
If this bill survives constitutional challenges, could Congress also tell me what books I have to purchase and keep in my home?
They would not be forbidding me from reading a book, and thus they would not violate the First Amendment.
And the sale and purchase of books certainly involves interstate commerce.
So, if the individual mandate survives, could Congress force me to purchase and keep specific books in my home?
Remember Nancy Pelosi said they had to pass it so we could learn what was in it?
Two judges have looked at it and it sounds to me like they don't know whats in it.
Just to "level the playing field"
If we still want to provide healthcare via an insurance model
-AND-
if we insist on eliminating all pre-existing conditions as a reason for denial of health insurance
-THEN-
we either need a mechanism to force "all in"
-OR-
we need to raise rates significantly to address the moral hazard problem.
1jpb: From one non-lawyer to another, my understanding is that since Obamacare has no severability clause, if one portion is struck down, the whole bill goes down.
"That the individual mandate is unconstitutional, of course, would not completely resolve the issue because legislation of such length and complexity often contains a “severability clause” – a provision that if any portion of an act is found unconstitutional, the remainder will still stand. But ObamaCare apparently contains no such provision."
Garage Mahal wrote: Hey the only guy I sent money too, and the only race I really care about is Feingold.
And you already told us that you'd swim a river of piss to vote him back in and all the rest of that stuff for that matter.
We need new material Garage.
Prepaid medical care is not "insurance."
AJ--
I didn't even mention State and Other Charges:
St. Croix County 911 Fee
Polk County Tax
Wisconsin State Tax
Charge for State Universal Service Fund Programs
WTF?
Buy gas. 51.3 cents on a gallon is tax. Look at your property tax. Divide 365 into it and find out what you're paying per day. State tax. We are getting the absolute fuck taxed out of us. Where does it all go? And then, to make every thing look worse, the governments, state and federal are unable to balance the books.
WTF?
The Dems engaged in verbal gymnastics with the bill because they knew it was a tax. This judge is not the final word on the matter. Perhaps he has been a judge too long and has mistaken what is written for what is.
We need new material Garage.
As if " wait until November when you get your ASS kicked!" is new material.
Ok, I'd vote for Feingold if I were a gut shot wolf bitch with nine sucking pups pulling a # 4 trap across a frozen Lake Monona with a face full of porcupine quills.
Alright I stole that from Tom Waits. Sorry, but I gotta go/
@C3
Just to "level the playing field" even more:
-AND- devolve more primary care out of the hands of doctors and into nurse practioners (already happening)
-AND- rethink the entire med school costs and consider doing what we did to bolster science education in the US after SPUTNIK
-AND- reduce ridiculous malpractice insurance premiums and the consequential slew of unnecessary testing which goes on everyday. This means tackling tort reform which even Howard Dean admitted hasn't be touched.
-AND- educate the poor about not expecting something for nothing.
-AND- finally, going through a protracted period of learning how to die with grace and dignity without having to have heroic measures applied as the default.
AllenS said:
"states, feds...are unable to balance the books".
That is the problem. We have to make the elected SOB's give us a financial statement every year. If they had been doing that, this govt pension insolvency and the social security / medicare bankruptcy could not have been hidden for so long.
“Congress should not be permitted to secure and cast politically difficult votes on controversial legislation by deliberately calling something one thing, after which the defenders of that legislation take an “Alice-in-Wonderland” tack and argue in court that Congress really meant something else entirely, thereby circumventing the safeguard that exists to keep their broad power in check,”
EPR said:
"finally, going through a protracted period of learning how to die with grace and dignity without having to have heroic measures applied as the default."
You first! Heh,
The Dems engaged in verbal gymnastics with the bill because they knew it was a tax.
So if its a tax..
Obama may have passed the biggest tax increase in history.. (right under our noses) during (his words) the worst recession since the great depression.
Add letting the Bush Tax Cut expire (another tax raise)
Add the extended moratorium on offshore oil drilling.. (increasing unemployment)
When Rush says Obama aims to destroy the country.. its beginning to get harder and harder for me to resist that assertion as over the top rhetoric.
Quayle @ 4:21 has exposed Obama-Pelosi Care for what it has always been intended to be. A complete tyranny in 400 or so Dems and one King. Does that remind any body of the fascistic government in Chicago where Michelle Obama first took pride in being among a ruling elite? Who you gonna complain to? The States will have become shadows with no power left, but who needs states anymore except for football games. And Christine O'Donnell who can see through their tricks has suddenly taken Palin's position as the government media's Retarded Female of the Month. Calling Tina Fey.
"AND- devolve more primary care out of the hands of doctors and into nurse practioners (already happening)"
Yes, it is. Just wait until next year. 'Triage', 'protocols' and 'guidelines' will run the health world.
But if you have symptoms that fall out of the algorithm (or take longer than 7 minutes to diagnose), it'll have to wait.
"We gots forms to fill out. Can't you see we're workin' here?! Get back in line."
Interesting, but ultimately what the various district courts write on these issues isn't going to matter much.
I don't recall offhand whether Congress included any special provisions in the Act regarding an expedited appeal, or a waiver of the normal 'final judgment' rule. Since no one has (yet) requested an injunction, there is no appeal by that route either. And mandamus would be a non-starter.
The judge has set a tight schedule for the summary judgment motions. My guess is that this one will be decided on the merits early in 2011.
So it looks like the only one of these cases heading up the appellate later for now will be the ED Mi case going to the Sixth Circuit. That court has suffered more than most recently from some frequently bitter left/right divisions, and this is just the kind of appeal that will bring them into play. In all events, that will probably be the first one to hit the SCOTUS, but not for quite a while yet (but probably before the election in '12). But the appeal in this case, assuming I'm right about a merits decision in early 2011, won't be far behind.
Pollo;
Just to "level the playing field" even more:
-AND- devolve more primary care out of the hands of doctors and into nurse practioners (already happening)
Fair point. But it IS free market competition. And while I believe a well trained family physician provides qualitatively better primary care than a well trained NP I have to admit the literature is spotty on that point.
-AND- rethink the entire med school costs and consider doing what we did to bolster science education in the US after SPUTNIK
I hope you're not suggesting throwing more money at Med School Education. I'm certainly no fan of med school curriculum but I don't want a NASA like response to its problems.
-AND- reduce ridiculous malpractice insurance premiums and the consequential slew of unnecessary testing which goes on everyday. This means tackling tort reform which even Howard Dean admitted hasn't be touched.
It is long overdue but we need to be honest, the effects on cost will be modest.
-AND- educate the poor about not expecting something for nothing.
Again a fair point but I would replace the word "poor" with "people" (as in ALL)
-AND- finally, going through a protracted period of learning how to die with grace and dignity without having to have heroic measures applied as the default.
I could not agree more.
"'Triage', 'protocols' and 'guidelines' will run the health world."
Good! You individual docs may think that you know all. But, you're wrong, your experiences are anecdotal. Expanding and implementing evidence based medicine is long over due. And, we need better, more complete data sets, hence searchable (but anonymous) electronic medical records.
Then, add algorithms that search the data from electronic medical records to suss out waste, fraud, and abuse (like a credit card company, or pay-pal does--because they actually care about not losing money).
Then, folks need to better feel the costs associated w/ their medical treatments. HSAs (as SteveM has) in combo w/ a catastrophic policy make sense. And, a system that involves at least some up front cost (even if there is a later reimbursement, e.g. France) makes sense too.
Sorry, but the time for slogan solutions that pick at the edges has passed. Cheaper medical care means less medical care, so we better figure out the best way to spend less. Evidence based triage, guidelines, and protocols here we come.
P.S.
Why didn't you call these things "death panels?"
Lesson of the Day:
Names matter.
AND- educate the poor about not expecting something for nothing.
Again a fair point but I would replace the word "poor" with "people" (as in ALL)
Isn't it nice that we have c3 here to provide the necessary correctives to Dr. Pogo's hyperbolic ranting and hatred for anyone financially inferior to him?
(I've been patted on the back of the hand for inadvertently referring to the real life name of another commenter here - even though the Blogress herself doesn't make it that difficult to determine. But regardless of Pogo's real identity, I think it's worth asking how he feels about evidence-based medicine and how familiar he is with actual literature on health care policy).
Thanks also to c3 for reminding his colleague of the financial futility of tort reform.
If you think it's only fair that physicians have that protection, then be honest for a change, Pogo, and fucking admit that's what your view boils down to.
As ijbp thankfully reminds us, individual physicians can be (they aren't always, but enough of them often are) so obstinate in their opinions and anecdotal observations, that unless they've got a study to refer to or are willing to look at, they risk coming off as useless as a robot with bad programming.
C3 redeems the bad name that physicians like Pogo are all to willing to give the profession.
Calypso amy be right about PB&J's question, but, even if he's not, I have the feeling it's like the old Apache torture - once the ants start nibbling, they don't stop. There is so much in ZeroCare that overreaches, most parts probably have multiple elements that are vulnerable to overturning.
I don't like Obamacare, and I want the PPACA wiped off the books.
However, I don't see why it would be unconstitutional.
If the federal government can declare securities fraud a crime, and impose penalties, why can't it declare lack of insurance a crime, and attach penalties?
Also: why is it a judicial matter whether the bill's sponsors called the penalty a "tax" or not? Where is the judicial authority to hold politicians accountable for what they say? Shouldn't the judge be 100% focused on the legislation itself?
Think of all the things that effect your health. Where you work. What you eat. Your hobbies. Your sex practices. Where you live. All of that will be controlled by the Government.
And they're not shy about admitting it if you listen carefully. They want to shepherd you into an early natural death if possible, but it'll be the gulags if necessary.
And the gulags are always necessary.
This whole farce is so Unconstitutional that it's a disgrace to the document to even discuss the issue.
Think of all the things that effect your health. Where you work. What you eat. Your hobbies. Your sex practices. Where you live.
In other words, think like an insurance company exec intent on fattening his next Christmas bonus.
Interestingly, physicians like Pogo already do. But only when it comes to the patients who are poor enough to warrant his condescension.
In other words, think like an insurance company exec intent on fattening his next Christmas bonus.
That's the actuary's job. The exec deals more with finance and investment.
Wrong Ritmo. Individuals don't act like Governmnets. They have neither the power nor the desire. Your scramble to equate Insurance companies (which pay for actual care) and the State (which mandates others pay for actual care) deliberately retards the discussion.
I don't expect to change your mind. You're one of those people who literally craves a Government that tells you what to eat, for God's sake. Just keep your self-abnegation to yourself and don't impose it on everyone else. That's all any conservative asks.
Ritmo...Could we be in agreement today? The cost savings for eliminating Med Mal lawsuits are 1% of the problem, and that Reform will turn the rights of a free people to compensation from a jury trial for horrible medical errors into small fines. Medical care at Emory or St Joseph's in Atlanta is superior in all ways imaginable. But they do make a mistake as humans will do every so often. But outside the upper middle class areas in Atlanta, medical care can be a bad joke with most of the doctor and hospital's extra efforts spent covering up the truth about sever injuries they have inflicted. Even in the best facilities, the patient should always have intelligent and demanding relatives stay with them if they want to leave alive.
Folks ... the federal government does not possess the authority to require us citizens to purchase products from private companies.
Especially companies who are turning around and using our money to re-elect their favored poltiicians.
If the government does possess this power, then it's time to eliminate this government and find better guards for our children's security.
If the government can force us to buy insurance, then the government can force us to buy anything. And it can decide what it's going to charge you for it.
That's SLAVERY - my fellow Americans. Are you going to be enslaved by your own government?
This. Will. Not. Stand.
The Supreme Court had better get this case decided correctly. Or we have no fucking further use of a Supreme Court.
Wrong Ritmo.
Individuals don't act like Governmnets. They have neither the power nor the desire.
Corporations do and both they and individuals desire power.
Your scramble to equate Insurance companies (which pay for actual care) and the State (which mandates others pay for actual care) deliberately retards the discussion.
I can't speak for what makes you feel retards your own thinking. I'm making points here that you simply can't refute.
I don't expect to change your mind.
Maybe that's because you lack the desire and the power to. ;-)
You're one of those people who literally craves a Government that tells you what to eat, for God's sake.
No I don't. Your lack for the ability to debate me competently requires you to make up that lie.
But that doesn't make it true.
Just keep your self-abnegation to yourself and don't impose it on everyone else. That's all any conservative asks.
I ask reactionaries like you to keep your lies to yourself and not expect them to go unchallenged.
That's all any rational person wants.
Ritmo...Could we be in agreement today?
It seems so. I have no problem limiting the damage awards somewhat but we should be honest in admitting that these restrictions don't seem to have a major impact on costs.
1jpb said re: 'Triage', 'protocols'
"Good! You individual docs may think that you know all. But, you're wrong"
That's a pretty weak strawman. But if anyone ever makes the assertion that docs think they 'know all', you've got a ready response.
As for Ritmo, well, meh.
"Well first of all, tell me: Is there some society you know that doesn’t run on greed? You think Russia doesn’t run on greed? You think China doesn’t run on greed? What is greed? Of course, none of us are greedy, it’s only the other fellow who’s greedy. The world runs on individuals pursuing their separate interests. The great achievements of civilization have not come from government bureaus. Einstein didn’t construct his theory under order from a bureaucrat. Henry Ford didn’t revolutionize the automobile industry that way. In the only cases in which the masses have escaped from the kind of grinding poverty you’re talking about, the only cases in recorded history, are where they have had capitalism and largely free trade. If you want to know where the masses are worse off, worst off, it’s exactly in the kinds of societies that depart from that. So that the record of history is absolutely crystal clear, that there is no alternative way so far discovered of improving the lot of the ordinary people that can hold a candle to the productive activities that are unleashed by the free-enterprise system."
— Milton Friedman
But Ritmo wants to crush people under the boot of socialism.
I wonder why?
What makes a man so wantonly destructive?
But Ritmo wants to crush people under the boot of socialism.
I wonder why? What makes a man so wantonly destructive
Programming error. We apologize. Ritmo was originally a Beta model, but it appears our software wasn't up to date when we released him.
Milton Friedman has hereby given Pogo license to use his greed as an excuse for getting most of his facts wrong while advocating against what others want.
Yep. Einstein was all about the greed. That's what made him interested in finding out how the physical universe works. What a weird non-sequitur.
Get off your butt and dissolve your labor monopoly (cartel) before you go lecturing your perceived inferiors on the supposed free market nature of medical care. You silly doofus.
What makes a man so wantonly destructive?
I dunno. Maybe I'll ask the guy who sneers at people in poverty for emulating the wastefulness exhibited by those "on his level".
I see.
Say, might you be missing another one: tall, thin, half-white, smokes on the sly?
It's greed that impels Pogo to see greater danger in regulating his cartel than in his lazy acceptance of it.
Apologies. We are working to correct the sector error in Ritmo's reasoning cache.
"Maybe I'll ask the guy who sneers at people in poverty for emulating the wastefulness exhibited by those "on his level".
Barney Frank?
John Kerry?
Rahm Emanuel?
I never detected any sneering in the above three individuals that I regularly do when Pogo berates the poor for being one-tenth as greedy as he is.
"...greed that impels Pogo to see greater danger in regulating his cartel..."
My cartel?
It's ...mine?
Joy, rapture!
Frabjous day!
A cartel, I have.
Mighty am I!!
Now I can sneer at those lowly beings who lack a shiny cartel like mine.
"I never detected any sneering in the above three individuals..."
Socialist thinking begets a certain thickness.
I prescribe one chapter of The Road To Serfdom each night for a week. Normal cognition should begin to return, and the sneering by the political class recognized with ease.
Your results may vary.
Void where prohibited.
Pogo,
WTF?
You prefer to have individual docs woking in their medical fiefdoms where (smart and large as they may be) their practices are inherently limited to their organization's ability to research and evaluate a (practically speaking) unlimited and often untested (or untestable, due to lack of data) medical community. And, you don't even attempt to explain why the country should finance this system when we could be using twenty first century software to help our citizens live better w/ evidence based 'triage', 'protocols' and 'guidelines' sussed out of (not yet developed) medical databases?
Some of you docs really suck.
I can see Pogo is uncomfortable in his newly discovered role as a pimp.
Pogo - if you don't like the hos, you must give up the dough.
You can tell Pogo is a shitty doctor by his unwillingness to admit for correction, let alone error.
The worst physicians are the ones who think they're literally gods who can never do wrong, and Pogo is evidently one of them.
The grip over society at the hands of his cartel will be a casualty of the information age. Must be a pity to have been brought up thinking that you can always know more than someone else when there are reams of quality data available to prove you wrong at every step.
Socialist thinking begets a certain thickness.
Which poor person has accused Frank or Kerry or Emanuel of sneering at them?
Much like your license, your cartel in hubris and condescension also remains more unmolested than you imagine.
In which Ritmo, once again unable to advance a reasoned argument, descends rapidly to name-calling.
No, yer a poo-head!
Poor poor Ritmo.
Needs intellectual Viagra, stat.
"Some of you docs really suck."
I agree, those strawman docs you created really suck.
An appeal to ideology is not a reasoned argument, Dear Pogo.
Is "intellectual Viagra" the best you can come up with? You realize it's just more of the name calling you deride, as witty as reciting it makes you feel.
Dammit Jim! I'm a Socialist Hunter. Not a doctor!
Let's cut to the chase, P-Go.
How much does all this health care reform business cut into your pride?
Did you want a referral to someone with whom you can explore these feelings?
Sure it is. Why waste discussion?
This is your level of talk, certainly, as measured by volume alone.
A bit like playing fetch.
@garage:
Heh.
That was good.
love you Pogo. Always
Now I know that Pogo's in favor of 'triage', 'protocols' and 'guidelines.'
That wasn't an obvious conclusion when he was mocking 'triage', 'protocols' and 'guidelines.'
Then feel good about not rising to the occasion.
I must have underestimated the degree to which studying colon transit time in the elderly leaves one unprepared for a policy discussion - save a handy retort for all those who dare disagree as "poo-heads".
Exactly, 1jpb.
What I was criticizing was how the concerns of the patient will be lost, because they are no longer the customer.
The gubmint will demand protocols and triage for political and financial reasons, supplanting medical ones.
The gubmint will demand protocols and triage for political and financial reasons, supplanting medical ones.
God forbid patients have a political voice.
Now I know that Pogo's in favor of 'triage', 'protocols' and 'guidelines.'
Shame on Pogo for being "in favor" of the law of supply and demand. Next he'll come out in favor of gravity, momentum, or... thermodynamics!
Ritmo,
Hayek was smarter than Keynes.
Fetch!
Shame on Pogo for being "in favor" of the law of supply and demand. Next he'll come out in favor of gravity, momentum, or... thermodynamics!
Nice way to dumb down the discussion, as I always knew you could.
Pogo will have a shred of credibility when his discussions of the economics of health care and supply and demand include the same contempt for his own licensing cartel that he currently reserves for the poor and patient advocacy groups.
Ritmoron raved: Much like your license, your cartel in hubris and condescension also remains more unmolested than you imagine.
It must require a good deal of patience for a physician to condescend to engage with someone like Ritmo whose unintelligibility, both verbal and radical, suggests that he may have forgotten his meds.
Fetch!
Obama will throw you into the poor house and distort the practice of medicine.
Fetch!
It's ok, Pogo. We know that never taking anything seriously is the only way you can preserve your pride, at this point.
I hate to repeat this for you, Ritmo, but I am in fact in favor of expanding medical practitioners far beyond the medical physician guild.
Have been for years. Said so on this blog before.
What's weird is that you're a socialist and should be in favor of union shops.
What gives?
"The gubmint will demand protocols and triage for political and financial reasons, supplanting medical ones."
This seems like such a lame talking point, especially from a doc who deals w/ insurance companies (assuming you're not in one of those giant clsoed systems, where you deal w/ in-house bean counters) (and the gov, if you take Medicare folks) who do precisely this .
The health care reform helps to add a lot more 'evidence' to evidence based medicine.
Home-bray (who has taken to sock-puppetry by removing the effeminate article "Elle" from his name) ranted:
"Ritmoron raved: Much like your license, your cartel in hubris and condescension also remains more unmolested than you imagine."
It must require a good deal of patience for a physician to condescend to engage with someone like Ritmo whose unintelligibility, both verbal and radical, suggests that he may have forgotten his meds.
How easily you forget that intelligibility depends on the intelligence of the audience, Home-Bray.
I hate to repeat this for you, Ritmo, but I am in fact in favor of expanding medical practitioners far beyond the medical physician guild.
You're disingenuous as always. To pretend that regulating the practice of medical insurance is as big a threat to supply and demand as licensing requirements shows just how difficult it is for you to prioritize a simple problem.
The comparative volume you reserve for one supposed outrage as opposed to the other is telling.
Heh. I knew you wouldn't respond except by evasion.
Tell me, why do you detest individual freedom so much?
Show me on the doll where the socialist touched you.
The health care reform helps to add a lot more 'evidence' to evidence based medicine.
This actually opens up a very simple proposition.
Ask Pogo how well he thinks restrictions on insurance payments are driven by evidence.
I betcha he'll refuse to answer the question.
Tell me, why do you detest individual freedom so much?
This isn't about individual freedom - except yours to believe that your profits will hurt worse under expanded access than under a broken cartel.
Either way, we are dealing with a market that is either needlessly distorted, or hopelessly prone to distortion. There are potentially a bunch of problems you could point out when it comes to health care, and I have no preference for a left-wing approach or a right-wing approach to addressing them. HSAs and medical boutiques would be great, if they worked. Problem is - much like tort reform - they don't, and that's not what the voters asked for.
Your definition of freedom apparently doesn't allow for the freedom to vote in a way you disagree with.
But you can, apparently, condescend to them for not being intelligent enough to persuade anyone otherwise. I guess that's what someone who gets his facts so wrong (see c3) would be willing to do.
This isn't about individual freedom - except yours to believe that your profits will hurt worse under expanded access than under a broken cartel.
Only government can make cartels possible. It was the same back in the 19th century with the railroads and nothing has changed.
Never forget evidence based medicine comes from the same place that still thinks Keynesian economics and the doctrines of Karl Marx work.
This is the Gospel according to Donald Berwick with the usual pseudo-academic blather attached.
There ya go, Pogo. Edutcher's taking up your case for non-evidence based medicine.
I'm sure your cartel and practice will have a great time marketing that one.
PB & J:
Do you really believe the crap you wrote? that medicine will be better when fed bureaucrats are in charge?
Pogo, P.C.
We take a look at what the evidence says, and we do THE OPPOSITE
The Republicans and Edutcher will love it. Mayo Clinic, probably not so much.
"If only patients had a political voice"
??? WTF Is that what the Upper East side crowd fantasizes about at their wine & cheese soirees?
I wouldn't know, A.J. You're the one who seems to enjoy working up a pressure ulcer on your frequent drives up and down the turnpike to the place.
Stay in Philly. You can catch the naked bike race, if nothing else.
Ritmo -
You're disingenuous as always. To pretend that regulating the practice of medical insurance is as big a threat to supply and demand as licensing requirements shows just how difficult it is for you to prioritize a simple problem.
Then if that's the case, perhaps you can explain why the entirety of the Democratic Party decided to tackle the medical insurance instead of licensing requirements.
After all, the whole goal was to "bend the curve" so "if you like your plan you can keep it."
So perhaps you have a good explanation why Obama and the entirety of the Democratic Party felt the need to massively overhaul the insurance market based on a series of lies when the REAL PROBLEM is medical licensure requirements?
So which is it, Ritmo: Are Democrats liars AND incompetents for trying to sell the public on a fix for the wrong problem, or just out and out incompetent for THINKING they were addressing the real problem when they were so far off base?
So which should be the basis for throwing all the Democrats (including Obama) out of office who sold the lie that is ObamaCare? Dishonesty or incompetence or both?
Answer the question your answer implied.
I stood in line at the DMV for a couple hours yesterday, and I really felt that my political voice was being heard.
Obamacare's going to be so awesome.
Ritmoron bumbled: How easily you forget that intelligibility depends on the intelligence of the audience, Home-Bray.
Of course it does. Recall this famous example:
"'Twas brillig, and the slithy toves
Did gyre and gimble in the wabe:
All mimsy were the borogoves,
And the mome raths outgrabe."
Simple fare for any lefttoad, right? LOL.
You truly are stump dumb, Ritmo.
Obamacare's going to be so awesome.
What do you mean going to be? About 10 of the provisions in ObamaKKKare have already kicked in.
You truly are stump dumb, Ritmo.
And yet you compare me to the genius of Lewis Carroll, Dingleberry Tumbleweed.
Don't you have some gay sodomites to arrest, Elle, Chief of the Butthole Police?
It sounds like an interest you have in common with Pogo, Chief Scientist on the Matter of Colon Transit Time in the Elderly.
What do you going to be? About 10 of the provisions have already kicked in.
And so far we've seen massive rate hikes, companies dropping plans, major employers getting free passes from the Obama administration, retirees being dumped into Medicaid, admissions from the government actuary that it bends the cost curve UP instead of down, seniors losing Medicare Advantage insurance, negligible participation in the high risk pools....
...and we're only 6 months into it.
Only idiots like Garage need to wait 4 years to see how wonderful the REST of the package is going to be since the frontloaded "good stuff" that was going to make sure that Democrats got re-elected in 2010 has been such an unqualified success so far.
Nice going, sparky. Any other brilliant suggestions or are you done embarrassing yourself for the evening?
AJ,
I very much want to have the feds create a universally compatible and highly detailed electronic medical records data base where patient names are excluded. Then, I want our universities, private companies, and government agencies to have access to this data set w/ the understanding that this is public information and resulting findings cannot be patented (too bad if this means the private sector may shy away, this is "our" personal data).
And, as you probably noticed, the gov already pays for about half of our country's health care bills. So, I would require the gov to fund its part of health care in the most efficient and effective way possible, as determined by studying medical records data bases.
BTW, any con who opposes evidence based medicine is foolish. You will never end Medicare, so the gov is always (and increasingly, based on demographics) going to be in the health care business. The question is, what is the best way to run gov health care. Asking if we should have gov health care is moronic.
AJ Lynch said...
PB & J:
Do you really believe the crap you wrote? that medicine will be better when fed bureaucrats are in charge?
PB&J's schtick is to take some piece of left-wing drivel, make a number of fallacious accusations against Conservatism, the Republican Party, or both, and inveigle otherwise serious commenters into defending proven policy against what he presents as proven fact when, in truth, it's only factual in the KosKidz world.
Dr Ezekiel Emanuel, brother of Tippytoes, almost certainly is a firm believer in this particular throwback to Richard Lamm.
For the record I do know that database is one word.
I'm even a certified Java programmer. But, that was a long time ago. And, I only took the test to prove I could pass it. I've never been a programmer.
ed,
I appreciate being compared to any of the Emanuel bros.
But, the one from Entourage would be my first pick.
Ritmoron spewed: Don't you have some gay sodomites to arrest, Elle, Chief of the Butthole Police?
In addition to being stump dumb, you appear to be preoccupied with buttholes.
you appear to be preoccupied with buttholes.
I'm actually wondering why I'm being bombarded by buttholes like you, Tex.
I guess I don't have the interest in policing them that you do, Tex. It takes a lot of preoccupation with something to want to involve the police in it.
Remember Lawrence v. Texas like you do the Alamo, Tex. Make that stand.
All the other assholes are depending on you.
If my comments triggered the Ritmo tirade I apologize to all.
Ritmo;
financial futility of tort reform.
I did not say futility. In fact I said
the effects on cost will be modest.
"Modest" and "futility" are a long way apart.
And I've said before that if BO had pushed for real medical liability reform with the passing of PPACA he would have gained the strong loyality of physicians on the left and right. Instead he and the Dems in Congress opted for a "study" (code word for "nothing").
And I feel very confident in saying that if you ask people, who do you trust more in making health care decisions: doctors or government; doctors will win hands down every time.
Pogo and I may disagree on how to "fix" healthcare but I'm confident that we'd agree that without the strong participation of physicians, any program will fail. Barack Obama DOES NOT have the strong participation/backing of physicians.
Man, this thread had great potential. I would have enjoyed discussing the Commerce Clause issue and how shocked I was that Congress didn't even attempt to add language that would have addressed these obvious Constitutional questions -- almost as if members wanted to fail.
Oh well.
7,
Can you confirm that there was no serverability provision? And, is it correct that w/o such the entire thing goes down in flames if any single aspect (out of the thousands of pages) is found to be unconstitutional?
P.S.
If you want smart legal talk, isn't Volokh a safer bet?
Ritmo...That is enough snark-cake for you tonight. You are hunting on a baited field and taking more game than your licence permits. Good night you Princes of Maine, you Kings of New England, and of Montana too.
When you've got your nose up Ritmo's ass, your cognitive ability is as warped as your judgment.
"I stood in line at the DMV for a couple hours yesterday, and I really felt that my political voice was being heard.
Obamacare's going to be so awesome."
I stood in line in California for more than a couple of hours, more like four, got all the way to the front of the line and was told my ID's weren't sufficient and was given a list of what they accepted. On a *lark* I quipped "Hey, what about my Air Force Reserve ID?" and I get, "Oh, that will work."
Since that wasn't on the list she'd rattled off because apparently she decided it wasn't necessary to mention, I was saved by one slightly snotty remark from having to spend another *entire* afternoon standing in line with my birth certificate.
The DMV (MVD, whatever) here in New Mexico is contracted out. There are offices all over the place, no wait, and helpful staff. Even going to a government location results in nearly no wait and *chairs*. North Dakota was the same. Easy and quick.
Can you confirm that there was no serverability provision? And, is it correct that w/o such the entire thing goes down in flames if any single aspect (out of the thousands of pages) is found to be unconstitutional?
I did see that comment above and my immediate reaction to the comment was that it sounded like wishful thinking -- somewhat like stop signs with white lines around them being optional.
As you note, the bill is really long and I have no idea what all it contains. It could contain money for a road to a hospital in Terre Haute, for example, and I highly doubt that any court decision could affect that portion of the new law.
If federal courts agree with me that forcing people to buy health insurance is not within the scope of the Commerce Clause, the immediate effect would be that the federal government could not use this law to force people to buy health insurance. It's hard for me to believe that hundreds of other provisions in the law would not still stand.
All of that said, though, I don't really know the right answer. Althouse?
Synova - My wife had that same experience except she got to the front of the line and left and has not gone back. It's been over a decade that she's gone without a license. "Truly powerful people do not drive," she has told me, "they are driven."
While I am strongly inclined to agree with you and everyone else concerning the heinous crappiness of the DMV and government service in general, and to agree that government needs to be contained and reduced, not increased, I have to ask you the same question I've been asking my wife for years: why can't you people bring the right records to get your drivers license? I mean, far lesser people have succeeded here.
You need not worry, C3. 'Tis not your comments (or anyone else who attempts reasonable replies) that triggers my tirades. Only the contemptibly unreasoned.
As for Obama's support among physicians, Pogo did a piss-poor job explaining that this even was his position. I never know what his position is and every time I ask for specifics, receive nothing but a never-ending tirade of John Birch talk and jokes.
But if you think that this is true, I would encourage you to break down your thinking by age cohorts. I don't get the impression at all that younger physicians are anywhere near as generically spiteful toward efforts at expanding coverage as older physicians are.
1jpb:
If you want smart legal talk, isn't Volokh a safer bet?
Truly amazing how many people haven't figured this out yet. Especially given their day job.
Did Ritmo Urban Dribbler just admit that he is an ass clown troll? I think he did.
"God forbid patients have a political voice."
Oh, patients should of course have a political voice. But when I'm on the gurney, I want it to be my own voice, and my physician's voice, making the calls, and not the "political voice", which may in fact be wielded by someone (through a 2000 page document that almost no on has actually read) who doesn't understand the immediate issues at hand.
Socialists: can't make a shoe that doesn't look like the box it was packed in, but damned good at killing people.
Synova,
I'm sure you know, but you can thank DHS for the ID nonsense.
When I retired from the Marines a couple of years ago, I went to get a retired ID and was told I needed two forms of ID to get my new ID. I was sent away because my current driver's license and my expired-by-a-day active duty ID were insufficient.
Another few layers of gubmint bureaucracy will not only make healthcare like totally awesome, but just flat out more fun!
My apologies to GMay and all.
Sometimes a mindless game of fetch is a welcome distraction from the worries of the day.
Plus, I figger that once Ritmo Underpants arrives, the thread is already stick-a-fork-in-it d-e-a-d dead.
"I have to ask you the same question I've been asking my wife for years: why can't you people bring the right records to get your drivers license? I mean, far lesser people have succeeded here."
Serious answer?
I'd gotten drivers licenses before and brought what seemed likely to be needed. The information was not readily available that this was wrong and as I explained *not even* when speaking to someone directly did I get accurate information about what was required.
My theory on this is that because the DMV employees did this every day they knew and understood the rules and requirements of this highly efficient process and... a disconnect happens... because it's so simple and makes so much sense to them, they become incapable of customer service helping people who only walk into their office once every several years.
There is also the dynamic involved that ends up with the rules in place to make the employees jobs easier, which all "customers" are supposed to comply to. This same dynamic happens in public schools and other bureaucratic situations. And certainly *certainly* organizations such as the VA hospitals, Welfare offices, and just about any government "service" organization.
My sister applied for food stamps once and reported the exact same sort of thing. The "customers" are supposed to know what is going on and how to have their stuff in order so that the employees work-place functions smoothly.
I'd like, please, never have to try to forcibly wring information out of the State Department ever again. No matter the question I actually asked, I got information on how to go about doing what I didn't need to do.
What amazes me, truly, is that I wonder about these people who want to put government in charge of everything... Haven't they had to deal with government *at all?*
"Haven't they had to deal with government *at all?*"
Yes.
And they like the power over other people. They like the comfort of paternalism/maternalism. They like groupthink and fewer choices or even none at all. They like seeming certainty over self-reliance. They abhor competition or decisions based on merit. They know they can't be fired unless they kill someone.
In short, they are afraid they won't do as well in the private sector. And queues seem a good trade for the uncertainty that freedom brings.
I think Obamacare's lack of a severability clause is fairly well established at this point. But I also know better than to think Big Brother can't get around that. A good discussion of the SCOTUS power to sever here. Also, I assume that given an imminent threat, Congress could just amend the bill with such a clause (in the lame duck session?).
I very much want to have the feds create a universally compatible and highly detailed electronic medical records data base where patient names are excluded. Then, I want our universities, private companies, and government agencies to have access to this data set w/ the understanding that this is public information and resulting findings cannot be patented (too bad if this means the private sector may shy away, this is "our" personal data).
What could possibly go wrong?
"I have to ask you the same question I've been asking my wife for years: why can't you people bring the right records to get your drivers license? I mean, far lesser people have succeeded here."
Showed up at the NV DMV the other day to get a NV DL. I have had DLs in 7 other states over the years, and all I have had needed was my old DL. Not any more. Now I need both proof of citizenship and proof of SS#. My expired passport wasn't good enough, and I surely didn't have an original copy of my SS card.
So, after tracking down all this information, that I haven't needed the last 10 or so times I switched DLs over the last 40 years, I find that AZ has an 8 year old hold on my license, despite my having had a CO DL for the last 6-7 years. And, of course, the check that was used to pay for that ticket was from 2 banks ago, and, of course, they never sent me the paper copy... I have 2 more years on my CO DL, and hope to have this all figured out by then.
I should note that part of my problem with driver's licenses is that when I switched from AZ to CO 6-7 years ago, the CO DMV discovered that I still had an active CO DL, or at least it wasn't totally inactive. So, I got my old CO DL license back, with a new picture. As a result, the AZ DL was not fully disabled, or some such thing. The CO DMV people punched a hole in it, kept it, and presumably sent it back to AZ, or some such. But, then, ten years before, that had supposedly happened in TX when I traded in that CO DL for a TX DL. So, which state DMV screwed up? CO? TX? AZ? UT? AZ? CO? NV? (the repeats show my moves over the last 16 years).
And, some wonder why so many of us don't really trust the government to do anything important well.
I stood in line in California for more than a couple of hours, more like four, got all the way to the front of the line and was told my ID's weren't sufficient and was given a list of what they accepted.
I discovered the trick here - ask them when they are the least busy, and have the shortest lines. Did this in NV, and it worked like magic. They want you showing up on slack days, so their crunch days are less stressed.
I showed up originally on Friday afternoon - 2 hour wait. But they told me to come back the next time right after lunch mid-week, which I did the next time. And, it worked like a dream - I watched her key in my order number, and by the time I turned around to see where they were in numbers, they were calling the person after me. Which meant that I just had to find the DMV clerk who had my number flashing above her.
Except that I hadn't finished the DL form yet, assuming that I would have at least a couple of minutes to do so before I was called...
So which is it, Ritmo: Are Democrats liars AND incompetents for trying to sell the public on a fix for the wrong problem, or just out and out incompetent for THINKING they were addressing the real problem when they were so far off base?
So which should be the basis for throwing all the Democrats (including Obama) out of office who sold the lie that is ObamaCare? Dishonesty or incompetence or both?
Dishonest and incompetent, both, of course. Most politicians are dishonest, which is why they get into office.
But the thing that you have missed here is that a lot of them are also Utopian. Or, at least progressives, communists, socialist, etc. are Utopian. They go through life with rose colored glasses as to the fallibility of human nature and the perfectibility of human endeavors, and esp., of government.
Until they understand that humans are greedy by nature, and are invariably willing to put their own self-interest and that of their families and smaller communities above that of the larger communities, and that there will always be more people and smarter people outside the government trying to game it, than within, they are going to continue to design and try to implement these massive, sure-to-fail, systems.
That later reminds me of a call-in on a late night talk show last night. He was expounding on that if we were just to do X (something inane), some international program would solve all our problems, since we are all willing to sacrifice for the community.
The problem with that was that he was talking about some trans-national community, and failed to understand that our natural selfish nature is to put the interests of our selves, our immediate family, our extended family, and our local communities, ahead of that of people on the other side of the world, or, indeed, often, on the other side of the state.
Think about it this way. One of our big driving forces is our genetic destiny. And that means making sure that our genes do well against those of others. To some extent, we are talking a zero-sum game here - by helping others who are not close to us, we hurt the chances of our genes dominating theirs.
That is human nature, because that is the law of nature, seen from the lowest to the highest of organisms, animal, plant, etc. And to assume this away is at best naive, and more likely self-delusional.
Ritmo Former Jungle something-or-other is less insightful than Jeremy and more prolific than Titus. That is to say, he pinches more loaves here than anyone else around here.
I don't think that Titus really deserves to be put in their company, despite your comments about loaves. He always lightens up the discussion when he participates through his stereo-typically gay self-indulgence and total self-absorption. It is playing so faithfully to that stereotype, regardless of how rancorous the discussion has gotten, that makes his contributions always so welcome.
WV: pater - half of what the libs want the government to be for all of us (the other half being his mate, mater).
In other words, think like an insurance company exec intent on fattening his next Christmas bonus.
Note the knee-jerk automatic villain here. This ignores that insurance companies are really not that profitable, in comparison with many other types of companies. Try comparing their profits per sales to those of, for example, Microsoft, Google, Apple, etc.
What the libs don't want you thinking about though is that government bureaucrats are just as greedy, and have many fewer constraints on their greed. At least with that insurance exec, his greed is constrained by the bottom line, and if a company pays too much for too little talent and work, they will suffer competitively, where their competitors will take their customers away from them. Or, their companies will go under. In either case, the market provides some discipline. All of which is missing when it comes to government bureaucrats and their legislative and executive government overseers.
Sometimes a mindless game of fetch is a welcome distraction from the worries of the day.
Nah. It's just the way your brain works.
Plus, I figger that once Ritmo Underpants arrives, the thread is already stick-a-fork-in-it d-e-a-d dead.
P-U-S-S-Y-!-!-!
You're just a pussy.
It's good to know that the stupidest threads are just ripe for the threadjacking. I'll be sure to leave a trail of turds on every one of the brain droppings here that suit my fancy. Getting you shit-eaters to complain about the taste after opening your mouths wide and saying "Ahhhh..." to every bad idea under the sun is very satisfying, I must admit.
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