June 25, 2015

Healthcare!

Roberts writes.

Subsidies are available!

Big sigh of relief.

Chaos avoided.

"This means that individuals who get their health insurance through an exchange established by the federal government will be eligible for tax subsidies."

The government wins. The Chief is joined by Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan. Scalia has a dissenting opinion.

And now this means that only another opinion by Roberts can come out today. But no, that's it for today. The rest, including same-sex marriage, will come tomorrow.

Here's the PDF of the opinion.

ADDED: The majority says that Chevron deference — which asks only "whether the agency’s interpretation is reasonable" — has never applied applied "in extraordinary cases," where there's reason to "hesitate before concluding that Congress has intended" to delegate to the agency the authority to "fill in the statutory gaps." Here, the tax credits are "key reforms, involving billions of dollars," with big "economic and political significance," and the agency making the decision is the IRS, which "no expertise in crafting health insurance policy."

Without Chevron deference, it's the Court's job to say for itself what the statute means.

The losing side in this case rested heavily on the argument that the statute was clear (that there were no subsidies for states that didn't set up their own exchanges and left it to the feds to set up exchanges), but the majority found ambiguity. It blamed Congress for "inartful drafting," for writing "key parts of the Act behind closed doors, rather than through 'the traditional legislative process,'" and for using "reconcilation" instead of leaving the bill open to debate and amendment.  In a sly reference to Nancy Pelosi's "we have to pass the bill so that you can find out what is in it," Chief Justice Roberts quotes an old Felix Frankfurter article — "Some Reflections on the Reading of Statutes, "47 Colum. L. Rev. 527, 545 (1947) — that described a cartoon "in which a senator tells his colleagues 'I admit this new bill is too complicated to understand. We’ll just have to pass it to find out what it means.'").

Since the text is ambiguous, the Court looks at the statute's "broader structure" for meaning, and the need to prevent the "death spiral" determines the outcome. The Court rejects the idea that Congress intended dire consequences, that it wanted to make an offer the states couldn't refuse, because Congress "expressly addressed what would happen if a State did refuse the deal."

AND: Justice Scalia dissents, joined by Justices Thomas and Alito. He finds clarity in the key phrase and proclaims: "Words no longer have meaning if an Exchange that is not established by a State is 'established by the State.'" He accuses the majority of "interpretive jiggery-pokery" in pursuit of "the overriding principle": "The Affordable Care Act must be saved."
The Court’s decision reflects the philosophy that judges should endure whatever interpretive distortions it takes in order to correct a supposed flaw in the statutory machinery.... We lack the prerogative to repair laws that do not work out in practice, just as the people lack the ability to throw us out of office if they dislike the solutions we concoct....

It is not our place to judge the quality of the care and deliberation that went into this or any other law. A law enacted by voice vote with no deliberation whatever is fully as binding upon us as one enacted after years of study, months of committee hearings, and weeks of debate. Much less is it our place to make everything come out right when Congress does not do its job properly. It is up to Congress to design its laws with care, and it is up to the people to hold them to account if they fail to carry out that responsibility....

318 comments:

«Oldest   ‹Older   201 – 318 of 318
mccullough said...

The GOP at the federal level is a joke. Not as bad as the Dems, but bad. If people want to take away their power, then they need to push for term limits, something non politician Dems and Repunlicans agree on.

stan said...

We’re all living in Chicago now. All that matters is power. Corruption, dishonesty, and fraud are the coin of the realm. Facts don’t matter. Law is merely whatever the powerful say it is. The media serve merely as propaganda whores for the dons.

Kids — the examples of how to succeed in life are all there for you: Clintons, Obama, Gore, Mann, Corzine, Reid, Roberts. This is America, Al Capone style. Except Capone faced a stronger rule of law.

If you aren’t part of the powerful elite, the question is how big a sucker do you plan to be? Can you imagine that there was once a time when people respected the role of law in America? Dishonesty, fraud, corruption, and lawlessness from sea to shining sea.

eddie willers said...

Everyone will have insurance. Few will have health care.

Laws have consequences.

kcom said...

This bears repeating over and over.

Short term chaos avoided. Long term chaos assured.

Sydney said...

According to this Kaiser cartoon there was supposed to be a wall around the states that didn't set up exchanges so their citizens wouldn't get any help. Check it out - at around 2:55. The government truck drives right by them without tossing out the money it tossed to the exchange states.

Sydney said...

^^Should be about 2:40

kcom said...

The era of bread and circuses has officially begun.

American Liberal Elite said...

It would be interesting to see instances where Scalia has been willing to correct statutory language where the context required it and the result was more congenial to Scalia's politics.

Jim Gust said...

Can't wait to see what President Rand Paul does with all this unrestrained imperial power.

wildswan said...

The flag they pulled down in Atlanta just got run up over the Supreme Court. It's called recycling.

Roughcoat said...

I feel like a chump for being a law-abiding citizen who plays by the rules. I feel like a sap. Nowadays it's just one goddamn thing after another. I getting a real bad attitude about government at every level that I didn't have before. I wonder where this feeling will lead me.

damikesc said...

I wouldn't hold your breath--anyone replacing Boehner will do the same thing to corral a majority party. It's one reason you don't really see a rival for his job.

He has massive problems. Somebody has to eventually knock him down. Hell, I'd settle for the House GOP conservatives to conspire with Dems to remove him.

1) He ONLY punishes people who vote conservatively. If they want to throw some pork into a Dem bill, they get no pushback.

2) He seems more interested in being chummy with Obama than his own caucus.

3) He is more blatant than most in partaking in failure theater.

Seriously, fuck him. If he is Speaker, I will not vote for a Republican for House ever. If McConnell remains leader, ditto for the Senate. And to get me to vote for a Republican for President is going to require a lot.

Bilwick said...

To use the terminology of the late, great Leonard Read: once again, the Command Society wins out over the Free Society. Thus we proceed further down the Road to Serfdom, with the State's usual gang of useful idiots (garage mahal, et al) dancing and singing merrily along the way . . . too stupid or naïve to realize eventually they end up in Big Brother's meat-grinder along with the rest of us.

Michael K said...

"It would be interesting to see instances where Scalia has been willing to correct statutory language where the context required it and the result was more congenial to Scalia's politics."

I assume you are searching for examples. Right ?

Anonymous said...

I may come around today to like Obamacare.

I heard the president on the radio.

1) More people have insurance today than ever before.
2) true average family is saving $1,800 a hear
3) More people are getting better health care which is resulting in fewer hospital visits.


Success!

Theranter said...

""It would be interesting to see instances where Scalia has been willing to correct statutory language where the context required it and the result was more congenial to Scalia's politics."

I believe at oral argument Scalia eluded to, in one fashion or another, Congress fixing the statute should they rule against the ACA in this case. I'm guessing that would be his take (versus correcting it himself) on other matters.

MikeR said...

"true average family is saving $1,800 a [y]ear"
I guess my family is not the true average. We looked into Obamacare options in Maryland, and found that while our Carefirst went up drastically last year, the equivalent Obamacare plans cost _more than twice as much_.
I am, of course, happy for the true average family that the president made up.

Beaumont said...

The Republican or Conservative strategy to repeal Obama Care by eliminating it in whole or part, is clearly weak. While we may arguable be able to provide the best healthcare in the world, the economics of U.S. Healthcare are clearly so dysfunctional as to be creating escalating problems with cost and accessibility. The Republicans/Conservatives have not come close to developing a plan that can effectively address these problems and improve them. Until they actually come up with something, I just see them as ineffectual young children, using techniques such as breath holding, tantrums, whining, and crying. Please Republicans come up with an adult alternative that is real, viable, and can actually change the economics of health care in a fashion that reduces cost and improves accessibility (and, hopefully quality).

khesanh0802 said...

I came in late and haven't had a chance to read all the comments, but I think Mark had it right at the top. The R's are lucky that they don't have to deal with the ramifications of lost subsidies at this point. I think that would have been just as disruptive as immigration. We are going to be living with Obamacare for a long time. What it needs is major reform and only popular pressure from a presidential election is going to get us to major reform. There's still a lot of bad news to come and it is going to be owned by the D's.

holdfast said...

Not what I wanted, but it's not an insane interpretation. Had Court held the other way, the current GOP Sellout Congress would have fallen over themselves to rescue Obama and Obamacare, and then the GOP would own the resulting mess forever. Probably better this way.

Anthony said...

I feel like a chump for being a law-abiding citizen who plays by the rules. I feel like a sap. Nowadays it's just one goddamn thing after another. I getting a real bad attitude about government at every level that I didn't have before. I wonder where this feeling will lead me.

I'm down that road as well. I really used to trust the government at least at some level. Ever since Kelo, I don't even trust the SC to bother with the written word of the Constitution anymore. Both Obamacare decisions have solidified their position, in my mind, as nothing more than agents of the government. I have neither respect nor trust for government at any level anymore.

Banana republic, period.

Curious George said...

"garage mahal said...
The Feds had to create an exchange for states that chose not to. That's how you sign up for insurance Corky. On the exchange. You cannot mandate an action and then not provide a conduit for that mandated action to happen.

No shit, Sherlock! Congress intent all along was to provide subsidies to people that live in states with asshole governors like Walker."

Again, you moron, the Feds had to have an exchange for those states that chose not to. The Feds didn't want to,but it was required. To keep the CBO scoring low; the exchange cost had to be off the Feds and on the States, so they put this big stick in...no state exchange no subsidies. They thought for sure that the States would cave. Like most things they do...wrong. This is fact. You're an idiot. Another fact.

Brian McKim and/or Traci Skene said...

Chaos avoided?

Have you been to a doctor's office lately?

The American Clusterf*** Act has brought little but chaos.

Douglas B. Levene said...

The silver lining is that this case might spell the beginning of the end of Chevron deference.

Etienne said...

The Republicans have no viable candidate yet. They better find one soon, as the current crop of wanna-be's are incapable of leading their party.

If I was to suggest someone, it would be Raúl Castro. He knows how to run a resort.

garage mahal said...

Curious George -- Thank God you get to keep your ObamaCare.

Curious George said...

Huge premium increases are coming. These subsidies won't matter much for the people receiving them...they still won't be able to afford insurance. EVen the bronze plans...with their huge deductibles.

BTW, I'm in this space. Providers are starting to treat all patients as uninsured, because most are still, because of the high deductibles, at point of service. Governement reimbursement is down, there still are millions on people without insurance, and those that have it have huge deductibles.

How was this a good idea again?

Curious George said...

"garage mahal said...
Curious George -- Thank God you get to keep your ObamaCare."

I don't have ObamaCare Corky. I have insurance through the company I own. No employer mandate yet. That ass fucking has been delayed because they Dems know it will be an ass fucking.

tim in vermont said...

If I was to suggest someone, it would be Raúl Castro. He knows how to run a resort.

Couple, Thanks, but I believe that the Democrats are already offering us the ruling-family qua oligarchy choice.

walter said...

Wait..I just heard it's working better than expected. All is well. Of course, it's not fully implemented but still..what could go wrong?

MadisonMan said...

the Democrats have avoided the employer mandate

Doesn't this happen in 2017? That's my recollection.

damikesc said...

2) true average family is saving $1,800 a hear

I'd love to see ANY documentation by our clown to back this up. Sounds like a number extracted from a rectum.


And he's only focusing on premiums and not the equally important deductibles which are insane.

The Republicans/Conservatives have not come close to developing a plan that can effectively address these problems and improve them.

You seem to miss something:

The Democrats haven't EITHER.

Their plan is making insurance more expensive while increasing ER visits.

A Republican Plan doesn't have to fix all issues...it just has to be better than the abortion that is ACA.

damikesc said...

Doesn't this happen in 2017? That's my recollection.

Nothing says "It's the law" like illegally stopping a tax for about 6 years because it's politically expedient to do so and will be sure to fuck over whomever follows our syphlitic donkey of a President.

tim in vermont said...

You would think they would implement it in 2016 so they could ride the good feelings to complete political domination.

Republicans can't oppose it because it is so popular, Democrats can't impose it because it is so unpopular.

The giveaways are all behind us, what is coming are the takeaways.

Michael K said...

"Have you been to a doctor's office lately?

The American Clusterf*** Act has brought little but chaos."

It is interesting. My wife and I are both in Medicare and I was hospitalized briefly about two years ago. I didn't think I needed it but the internist I go to now wanted me to go in and I did. Trying to be a good patient.

My wife was hospitalized last week for a chronic lung problem that requires IV antibiotics. The pulmonary guy, who I've known for 30 years, told us to go to the ER and he would send orders. We did that a week ago Monday and waited two hours among all the illegals and nothing happened. I said, "Why can't you just admit her ?" He said, "The days of direct admit are gone forever." Then he said, "Well go over to admitting and we will see what happens."

She was admitted but the nurse on the floor said, "Dr ____ will be in trouble for doing this."

This doc has been on the staff for 30 years and apparently is not allowed to send someone for admission. They must be screened by the ER docs who are on a hospital contract, with criteria not disclosed, to decide who gets admitted. This is the hospital whose staff I joined in 1972. I would not go there now.

The hospitals were eager for Obamacare and they have consolidated as vertical monopolies buying up doctor's practices and they now have iron control of doctors' lives. It's interesting to see how this is playing out.

I finally got her home Tuesday night. She wanted to go to an infusion center to get her IV antibiotics and stay home otherwise but they could not figure out how to do that. She went in yesterday for her first treatment; the IV is in her arm and all she needs is to be hooked up for an hour. The people at the "day surgery" center, which is all they have, argued with her that she had to be admitted for this. She finally convinced them to do what they were supposed to do.

She was an ICU nurse and I was a surgeon there for years. I pity the non-medical person who tries to negotiate the maze.

mccullough said...

This was definitely a compassionate conservative ruling.

damikesc said...

You would think they would implement it in 2016 so they could ride the good feelings to complete political domination.

You'd think that, wouldn't you? Such a popular and legal law and all --- why is it not ALL being done right now?

You know, as legally required by this now totally legal law that is legal and everything.

damikesc said...

This doc has been on the staff for 30 years and apparently is not allowed to send someone for admission. They must be screened by the ER docs who are on a hospital contract, with criteria not disclosed, to decide who gets admitted. This is the hospital whose staff I joined in 1972. I would not go there now.

Wasn't Obamacare supposed to REDUCE ER visits?

garage mahal said...

That ass fucking has been delayed because they Dems know it will be an ass fucking.

Well, Republicans have a backup plan and will reveal it right before 2016 and victory will be theirs. Super Top Secret Plan. Haha. Just kidding. How does the latest ObamaCare loss taste?

Matt Sablan said...

I don't understand why people keep saying Republicans have no alternatives. Jindal, Paul Ryan and a couple of others have all floated ideas of varying levels of specificity. It's just wrong to state no plans have been offered. I think there was even some legislation drafted that got killed at some point. It's a nice talking point to sway people who don't know better, but it is dishonest.

Anonymous said...

Blogger Matthew Sablan said...
I don't understand why people keep saying Republicans have no alternatives. Jindal, Paul Ryan and a couple of others have all floated ideas of varying levels of specificity. It's just wrong to state no plans have been offered. I think there was even some legislation drafted that got killed at some point. It's a nice talking point to sway people who don't know better, but it is dishonest.


My favorite plan is quite specific and short. Repeal every word. Period.

You know, health insurance and health care didn't start in the United States with Obamacare.

damikesc said...

Hey, that hack of OPM includes such lovely stuff as audits for people requesting security clearance.

But don't worry --- they won't lose your medical records. The government totally learned their lesson after all those firings due to the OPM...oh, wait.

Just remember, Progressives Who Love Privacy --- when your stuff is leaked/hacked (and it will be), you voted for this. Happily.

damikesc said...

I don't understand why people keep saying Republicans have no alternatives. Jindal, Paul Ryan and a couple of others have all floated ideas of varying levels of specificity

And, after today, how specific do they really need to be, amiright? We have a Court that will fill in the blanks.

Brando said...

"I don't understand why people keep saying Republicans have no alternatives. Jindal, Paul Ryan and a couple of others have all floated ideas of varying levels of specificity. It's just wrong to state no plans have been offered. I think there was even some legislation drafted that got killed at some point. It's a nice talking point to sway people who don't know better, but it is dishonest."

I think it's less that "no alternatives" have been offered and more that those alternatives went nowhere--even in the GOP. If the GOP united behind a new plan, and rolled it out in the media and put a PR campaign behind it, then at least there would be something to debate. But I'm not aware of any floor votes on GOP plans, only floor votes on straight repeal (that passes the House, dies in the Senate, repeat).

Part of it I suspect is that while there's many constituencies (even liberal ones) that oppose the ACA, they oppose it for different reasons and differ even more on what they're replace it with. It'd make sense at least for some of these groups to merge ideas into a less than perfect but still better than the ACA status quo sort of plan.

Otherwise, get used to the ACA, until it either gets better or implodes on its own.

Michael K said...

We are very close to the point that even a Medicare patient will need to pay cash for a reasonable physician. The good ones are dropping all insurance and Medicare.

About five years ago, I met the only Board certified Geriatrics specialist in central Iowa. She had dropped Medicare because shows being harassed and threatened by Medicare for seeing her homebound elderly patients too frequently.

DROPPED MEDICARE ! All her patients are over 65.

She was accepting Visa and MasterCard and was making a living and much happier. This is the future, folks.

A friend of mine had a total hip done last year by the best arthropod in Santa Monica (Obama country for fundraising) who accepts only cash. No insurance or Medicare.

Anonymous said...

Michael K;

The hospitals were eager for Obamacare and they have consolidated as vertical monopolies buying up doctor's practices and they now have iron control of doctors' lives. It's interesting to see how this is playing out.

I finally got her home Tuesday night. She wanted to go to an infusion center to get her IV antibiotics and stay home otherwise but they could not figure out how to do that. She went in yesterday for her first treatment; the IV is in her arm and all she needs is to be hooked up for an hour. The people at the "day surgery" center, which is all they have, argued with her that she had to be admitted for this. She finally convinced them to do what they were supposed to do.


My heart goes out to you and your wife, Michael. And to my parents. Eventually, I'll be in your situation.

I was speaking to my boss a few weeks ago about Obamacare. He is a Democrat and considers himself pretty middle of the road (He votes for Republicans sometimes). His opinion is, in 20 years (He is 55 now) they should just cut off all medical care for him and anyone else who is that age. I was surprised that a couple of the younger guys in the group. The consensus seemed like, "Yeah, screw the old people. They are just a drain on society anyway."

Seriously, I was quite shocked about this conversation. They were so nonchalant. Sincere. I felt like I was in an old movie, Logans Run.

Today I heard Obama mock death panels again. It's not funny anymore.

Brando said...

"You know, health insurance and health care didn't start in the United States with Obamacare."

It didn't, but look how the conventional wisdom changes in such short time.

I would have liked a series of reforms that concentrated first on increasing competition and transparency in medical billing, to bring down costs. Increasing access has to be secondary to that.

I'm also fine with consumer protections--for example, a law requiring that no one be required to pay a non-emergency medical expense until they have been informed of their final out of pocket expense and agreed to the procedure. The fact that you often find out months later what will be paid for and what won't is madness. Imagine buying a car that way--"sir, we will tell you what you owe on this new sedan after we find out how much some third party will reimburse us, and we'll be negotiating the price with them. And no, you have to commit now to paying that unknown price later." Seems a simple fix, but not if you let insurance companies write the law for you.

Matt Sablan said...

One of my major issues with drafting ACA is that a lot of the super popular stuff could have gotten passed, easily, as stand alone legislation with quick wins for both Obama and Republicans. Instead, they married it to a bunch of contentious/out right bad ideas, and tried to force it through without pretending to care what half the country thought.

All of the really, really good ideas -- if we repeal Obamacare, could probably be passed and signed the very next day, no matter who has the majority.

Towhee said...

My father's generation of Republicans had Earl Warren, this generation will have John Roberts.

Big Mike said...

Obamacare is alive and Patrick MacNee is dead. There's something wrong with this world.

Lewis Wetzel said...

Eric wrote:
"His opinion is, in 20 years (He is 55 now) they should just cut off all medical care for him and anyone else who is that age."
Ask him again when he is 74.
I do fear the millenials. They grew up in a world where the values I grew up with -- love of America, love of freeedom, pride in personal accomplishment -- have been rendered meaningless.

Big Mike said...

@eric, it's the Democrats' answer to the old question about what to do with the Baby Boomers when we retire.

Brando said...

"One of my major issues with drafting ACA is that a lot of the super popular stuff could have gotten passed, easily, as stand alone legislation with quick wins for both Obama and Republicans. Instead, they married it to a bunch of contentious/out right bad ideas, and tried to force it through without pretending to care what half the country thought."

That's my thought--some of it could have gotten bipartisan support. I think the Obama team just truly believed this would be a big, history changing thing like Social Security, and make them forever beloved, and give them the political capital for other things.

Anonymous said...

Blogger Terry said...
Eric wrote:
"His opinion is, in 20 years (He is 55 now) they should just cut off all medical care for him and anyone else who is that age."
Ask him again when he is 74.
I do fear the millenials. They grew up in a world where the values I grew up with -- love of America, love of freeedom, pride in personal accomplishment -- have been rendered meaningless.


We also grew up with respect and love for our elders and elderly.

But no one thinks of the scapegoats. When it hits the fan, there are always scapegoats and it won't be the rich.

It'll be

1) Elderly
2) Illegal Immigrants
3) Those on welfare
4) The crippled

We like to think of ourselves as a great and wonderful society. We are, because we can afford to be. When we can no longer afford it, the masses will rise up and they will need to be fed a scapegoat.

damikesc said...

Millenials worry me also. I'm making sure to instill in my kids a love of country..but it's hard since I hate what the US is now

Michael K said...

"Otherwise, get used to the ACA, until it either gets better or implodes on its own."

The alternatives were experiments that largely failed to control costs. HMOs and "Managed Care" were both Republican plans.

The problem is that market-based solutions look too cruel to the ruling class whose health care is paid for by the feds.

What young people need are catastrophic care policies that cost about 50 bucks a month when you are 25 or 30.

Pre-existing conditions should be in a risk pool that is far less expensive in tax dollars than what has been done.

Obamacare was another iteration of Hillarycare which failed because she tried to exclude insurance companies. They beat her with the ad campaign in 1993.

Health insurance is a money loser for the past 50 years. That is because it is not insurance. It is prepaid care with no cost control.

A market-based approach would pay for insurable events like heart attacks and accidents. Routine care would be paid for in cash, possibly out of HSA accounts.

Medicare is a problem but I have previously advocated using the French approach to health insurance. There is a series of posts here for those interested.

Michael K said...

" His opinion is, in 20 years (He is 55 now) they should just cut off all medical care for him and anyone else who is that age. "

They will. It is called "Bankruptcy" by some.

MeatPopscicle1234 said...

And what you people fail to realize is that there WILL NOT BE A 2016 election... This is all just preparation for what comes next, but 2016 is the year when everything hits the fan and when we come out the other side, "America" as we know it will not exist, just a one-world system ruled by the international satanists and the spirit of evil that they worship. the flames of hell are getting hotter indeed...

damikesc said...

The alternatives were experiments that largely failed to control costs. HMOs and "Managed Care" were both Republican plans.

Where is ACA "controlling costs"? I'm not seeing it. If you're going to say a plan is bad because it doesn't do so, then the current plan BEST be doing that, wouldn't you think?

What young people need are catastrophic care policies that cost about 50 bucks a month when you are 25 or 30.

But we HAD those.

Pre-existing conditions should be in a risk pool that is far less expensive in tax dollars than what has been done.

That is fundamentally impossible. If somebody is going to need dramatically more care, it's going to cost more. Sticking them in a pool is going to increase their costs exponentially.

Anonymous said...

market-based approach would pay for insurable events like heart attacks and accidents. Routine care would be paid for in cash, possibly out of HSA accounts.

I believe Ben Carson has floated an idea like this.

Michael K said...

"Where is ACA "controlling costs"? I'm not seeing it."

It's not that is why it is unsustainable.

"Pre-existing conditions should be in a risk pool that is far less expensive in tax dollars than what has been done.

That is fundamentally impossible. "

Think for a moment about how many people actually have real pre-existing conditions. The risk pools would be a small fraction of what is being thrown away on useless stuff by Obamacare. Here is an analysis .

Obamacare threw a nod to the high-risk pools concept as a bridge to 2014, when the law bans insurers from turning customers away on the basis of pre-existing conditions. But the Obamacare pools were poorly designed. “It is clear from the language of the legislation,” wrote Jim Capretta and Tom Miller in National Affairs in 2010, “that these high-risk pool provisions were crudely cobbled together as an afterthought to Obamacare’s other, more sweeping reforms. Little press or public attention was paid to them either before or after the bill passed. As a result, these provisions are likely to exacerbate the problems faced by states and patients, rather than resolve them.”

There's more.

ObamaCare spends $2.6 trillion in its first decade of full implementation, largely to ensure that those with pre-existing conditions have access to coverage. At this rate and based on these metrics — $2.6 trillion in spending, and 56,257 participants – the federal government will spend $4,621,647.08 per year for every person with pre-existing conditions newly enrolled in coverage. That’s not just enough money to buy each person with pre-existing conditions a platinum-plated insurance policy — that’s enough to buy each one a small hospital.

Feel free to criticize that analysis. It just isn't that expensive when you take the number of real pre-existing conditions. The French system has a list of conditions, like cancer, diabetes, etc. that the plan pays 100% of the cost for. If you have such a condition and get another unrelated illness, you have to use the regular plan.

Hammond X. Gritzkofe said...

Justices beclown themselves.

Public belief in Rule of Law plummets.

tim in vermont said...

How does the latest ObamaCare loss taste?

Why don't you call Speaker Pelosi and Senate Majority Leader Reid and celebrate the ongoing political juggernaut that is Obamacare with them?

jr565 said...

People who have to pay more in subsidies should all pool together, get John Roberts's address and send thank you letters where they thank him for their raised subsidies which he forced to remain by essentially saying words don't mean what they mean.

Have them all delivered en masse and dumped on his lawn.

I Callahan said...

Haha. Just kidding. How does the latest ObamaCare loss taste?

This is where we're at, folks. Americans wishing hurt and bad on other Americans.

Yup. Most inclusive and least divisive president in the history of the U.S.

tim in vermont said...

The big payoff of being a liberal is that you get to hate on so many Americans and feel superior for it.

Michael said...

Michael K

Appreciate your observations and am enjoying your book, by the way.

Thank God I am healthy and have the financial ability to buy my way out of a lot of trouble or to purchase a spot at the head of the line.

My prediction is that splendid medical facilities with well trained nurses will crop up on the Mexican side of our borders for those willing to pay. Nursing schools could be built in connection with the hospitals/clinics and a thriving business could be concocted that would also do a lot of good to those on both sides of the border. Doctors could be paid fairly.

I was shocked recently when an ortho friend of mine told me how much he personally made on hip replacements. It made me think I would not necessarily want to be worked on for that little bit of money.

Gahrie said...

What exactly am I supposed to teach my students next year when we come to the separation of powers?

Seriously, I refuse to lie to them, so what do I say?

Marty Keller said...

Mr. Cook correctly notes that this train turning our backs on our founding principles of individual sovereignty, rule of law by a specifically and intentionally constrained federal government, and a system of checks and balances to keep it that way left the station a long time ago. It started in 1937 when the Supreme Court caved to FDR and began concocting defenses of the various New Deal programs that it had for the previous four years found unconstitutional.

That was bad enough but the sorry truth is that, by and large, the citizenry of our country supported this then and have continued to do so with varying degrees of intensity since.

The American system was always an experiment, not a guarantee. We now longer feel the need to "refresh the tree of liberty with the blood of patriots and tyrants"; instead we elect our tyrants or appoint them to the Supreme Court and the EPA, and we belittle and marginalize our patriots and hope to take all their guns away in the name of "the children." We finally have the response to Franklin's challenge, "We have given you a republic, madam, if you can keep it."

It seems we cannot.

Michael K said...

I doubt the Mexican side hospitals will appear. There may be Caribbean clinics but, until Obamacare is made obligatory for doctors as is proposed in Massachusetts, I doubt there will much movement. Canada has opened many private clinics and there may be a shift in the opposite direction of all the southbound treks for care.

The free care will be an incentive for those who like free stuff but the middle class has still not seen much of Obamacare. That will be the test.

Hammond X. Gritzkofe said...

There must be some rational explanation for this decision. Perhaps Obama has photographs of Justice Roberts in a menage-a-trois with a dog and a goat.

kcom said...

"Logans Run"

They played Logan's Run on TCM last night at midnight. Coincidence?

tim in vermont said...

I have seriously changed my mind on single-payer. I just think it should be implemented with the same kind of regressive taxation they have in all the countries where it is working.

I am not sure how all of the players who get forced out of a job or who have their businesses basically nationalized will be compensated though.

I guess they won't be compensated, they will be demonized so that people cheer at their rape.

Beloved Commenter AReasonableMan said...

For an affirmative action hire Obama seems to be doing OK. Just this week he got the Republican congress to sign over all the power he wants on trade and the conservative leaning Supreme Court validated his signature legislative achievement for a second time.

Lewis Wetzel said...

Despite today's court rulings, If you are a serious Democrat (and I imagine that there are such things), the future looks cloudy. In small-d democrat processes at the national and state level, you've lost whatever you gained in 2006. Obama may not care about getting elected, but you do. Your presidential front runner is a 67 year old woman with no natural base of support and no natural political skills. For backup, you've got the 74 year old Bernie Sanders and the 73 year old Joe Biden. If you dig deeper you get the 65 year old Lizzie Warren. You can only ban the confederate flag once. Maybe Hillary promise a ban when she headlines this week's Democrat Jefferson-Jackson dinner?

HoodlumDoodlum said...

Beaumont said...Please Republicans come up with an adult alternative that is real, viable, and can actually change the economics of health care in a fashion that reduces cost and improves accessibility (and, hopefully quality).

Or you could have said "please Republicans come up with an adult alternative that repeals the existence of supply and demand." Or does "making someone else pay" qualify as "chang[ing] the economics of health care" to you? Please think of any other issue, topic, or good where the Gov is capable of making something less expensive overall, more widely available, and of better quality, at no net cost. Gov can shift costs. It can make things affordable by fiat (setting a max price), but can't simultaneously increase access (unless it could legally require Drs, nurses, etc to work) and improve quality. Hint: "quality" in healthcare has a lot to do with new research, techniques, drugs, etc. Healthcare would be relatively cheap if we only used tech from, say, 1975. Somehow people find that unfair, though.

Government isn't magic, Beaumont. We can't consume more than we produce in the long term. OCare doesn't do all the things you're asking the Repubs' plan to do--it can't. I hope the irony of saying Repubs aren't serious until they put forward a plan that depends upon the suspension of objective economic realities--a childish dream, in other words--isn't lost on you.

Anonymous said...

Blogger Gahrie said...
What exactly am I supposed to teach my students next year when we come to the separation of powers?

Seriously, I refuse to lie to them, so what do I say?


That it is a quaint notion whose time has passed.

HoodlumDoodlum said...

ARM said...conservative leaning Supreme Court validated his signature legislative achievement for a second time.

I don't think "validated" is quite the right word, ARM. Also when it's cute that when Dems couldn't get their legislation passed it was all the fault of the Party of No! and none of the President's, but now that the Repubs help get bills out it's on account of that same President's political skill.

Lewis Wetzel said...

If only the Founders had recognized the possibility that the Federal government -- the least democratic level of government -- could run amok, and written down a set of rules describing what the federal government was and was not allowed to do. Of course, you'd need a special panel of judges to evaluate the laws passed by the Federal government and determine whether or not they followed these rules.
I know. Crazy talk. A fellow can dream, can't he?

Etienne said...

The best thing that could happen now, would be for the States to realize they've had their sovereignty attacked.

The way forward is an Article V Convention. The mere threat of one is usually enough to get Congress to act.

The way forward is a balanced budget Amendment. I would propose that the deficits only be allowed to exist for four years out of each ten, unless Congress declares war.

That will run the socialists to ground, where they can be finished off every election.

Seeing Red said...

Eric, you should have just asked him " why wait?"

Gospace said...

"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances"

But clearly it doesn't include hate speech, because hate speech obviously isn't protected speech, and since Congress determined criticizing the President is hate speech, your death sentence is hereby upheld.

Lewis Wetzel said...

"The way forward is an Article V Convention. The mere threat of one is usually enough to get Congress to act."
In the current environment, the feds would simply ignore the vote for an article V convention. If necessary, they will declare the vote of a sufficient number of states to be invalid. There is precedent for this. Lincoln refused to acknowledge the vote of the Missouri legislature to secede.

Beloved Commenter AReasonableMan said...

Coupe said...
The way forward is a balanced budget Amendment. I would propose that the deficits only be allowed to exist for four years out of each ten, unless Congress declares war.

That will run the socialists to ground, where they can be finished off every election.


Those pesky socialists could just declare war on Christmas and run deficits forever.

Henry said...

Those pesky socialists could just declare war on Christmas and run deficits forever.

Zing! LOL.

Lewis Wetzel said...

"Those pesky socialists could just declare war on Christmas and run deficits forever."
Because we live in a country that guarantees freedom of religion, ARM, you are free to ignore the nativity scene your township hosts during the Christmas season. What? Your township doesn't have one? Why not?

Hammond X. Gritzkofe said...

Your "Healthcare!" caption for the topic is misleading, Althouse.

The legislation at issue is about health insurance, not healthcare.

Carol said...

Ehh, my gut: it wasn't likely the Court would get all technical about wording at this point. If the feds could pull off SS and Medicare, they can do ACA.

Bleach Drinkers Curing Coronavirus Together said...

Medicare is a problem but I have previously advocated using the French approach to health insurance. There is a series of posts here for those interested.

Lol. Really? You? The French system was ranked best in the world 15 years ago (probably still is) but obviously requires a level of micromanagement that Americans can't do. However, the equivalent result is being achieved by making reimbursement contingent on meeting core measures defined by professional guidelines themselves as best/most effective practices. That doesn't stop hospitals from setting their own admissions criteria or practices as per your experience.

High risk pools sounds like an interesting idea as then those markets could be addressed and subsidized separately, rather than on the backs of the generic patient. Of course, you'd probably also want to keep cross-state border markets opened to expand them.

And then the most important thing would be taxing the fuck out of all the preventive malfeasance that causes at least 1/3rd of our problems today, and costs. Kummerow's testimony to FDA about the dangers of trans-fats in the 1960s, alone, led to an impressive, immediate drop in fatal heart disease. Slapping a $10 to $20 per pack tax on cigarettes would easily slash the ridiculous and largely voluntary burden of lung cancer, emphysema and heart disease even further.

But how to deal with obesity is anyone's guess.

Brando said...

Having read the opinion and dissent--what terrible legal reasoning. Regardless of the subject matter, the concept of the Court reinterpreting an unambiguous provision is vile and dangerous. Something is very wrong with Roberts and Kennedy. I suppose they let political pressure get to them.

Brando said...

Here's a question--where does the subsidy money come from if the ACA taxes aren't enough to pay for them as well as the risk corridors? Treasury on the hook?

Lewis Wetzel said...

"And then the most important thing would be taxing the fuck out of all the preventive malfeasance that causes at least 1/3rd of our problems today, and costs."
Not wearing an appropriate SPF sunscreen should become a federal offense.
Also, let's can the cannabis. A $20-$30 per joint tax should be sufficient -- to start. Federal prison for cannabis users can wait until after the election.
Those big tubs of buttered popcorn you get at theaters will have to go. Not banned, but make people buy one kernel of pop corn at a time. And Big Gulps. Those things are diabetes in waxed paper cup.
As Captain Terril said in The Outlaw Josie Wales, "Doin' Right Ain't Got No End."

Known Unknown said...

A friend of mine had a total hip done last year by the best arthropod in Santa Monica (Obama country for fundraising) who accepts only cash. No insurance or Medicare.

So, you're saying that Obamacare will ultimately hurt poor people most? I'm shocked, I say, shocked!

n.n said...

With nearly $20 trillion dollars in debt, Americans are still indigent and homeless, and even unidentified. Obamacare will only be a revenue generator with establishment of selective-child and euthanasia policies. We already have selective-child policy. I wonder when they will expand pro-choice to normalize euthanasia of unwanted and inconvenient human lives.

Michael said...

R&B
"But how to deal with obesity is anyone's guess."

Either the culture changes and reintroduces shame and ridicule or it becomes cool to practice self restraint and the delay of gratification. Not sure any intervention by authorities can work.

n.n said...

EMD:

Poor people, and everyone else without sufficient leverage to compensate for a diluted economy, health care, etc. They can't redistribute debt forever to the rest of the world. They can't compensate for loss of forward demand forever through excessive and illegal immigration. They can't hide the consequences of selective-child policy forever through "dreamers", etc. They can't hide the consequences of a State-established pro-choice doctrine that is antithetical to human and civil rights, and the rule of law.

That said, I wonder who will be the next unfortunate bastard to be triggered by their degenerate policies.

Lewis Wetzel said...

Black people suffer from diabetes and heart disease to a greater extent than whites. Also they engage in what R&B calls "preventive malfeasance" to a greater extent than whites.
This means that the federal government will have to exercise more control over the lives of Blacks than control over the lives of whites. Perhaps taking away their children and giving them to white families will be an option, or triaging them out of the health care pool, or simply deporting them en masse. I'm sure there are progressive directives left over from the Wilson administration that can be updated and implemented.

Lewis Wetzel said...

"fine. Go ahead and have your Downs Syndrome baby. But if a doctor so much as gives it an aspirin, it's a felony."

n.n said...

The obesity epidemic was in part caused through social policies that normalized or promoted dissociation of risk and rejected religion/morality or self-moderating, responsible behavior. Perhaps they can reintroduce prohibition to curb people's appetites in the same way that the selective-child policy worked to curb the Posterity epidemic.

hombre said...

Ah, here's R&B proposing the nefarious sumptuary tax as the means by which "1/3 of our problems" can be solved. (6:46)

Terry, unmindful of the potential risk of Ritmo-baiting, follows up with a brief list beginning to demonstrate the oppressive nature and logical absurdity of that approach. (7:11)

Let's watch to see what happens.

machine said...

"Over the past year, every tax seminar I attended concluded that the exchanges would be upheld. Treasury defined “exchange” as having the same meaning as found in DHS regulations. Not one single tax professional ever thought that the result would be different."


good day pretenders...

Lewis Wetzel said...

I live for danger!
I don't smoke da' kine. You can tax the hell out of that, R&B.
I feel the same way about rap music. I don't want to pay for anyone's hearing aid if I don't have to. Ban it or tax it, your choice.
Tell me again why we let people drive cars that are capable of exceeding the legal speed limit? Let's call it the "fast and furious" tax!
The children of single moms have elevated health risks. Pre-marital sex? Banned! Divorce? Banned!
But only for the most progressive of reasons. We aren't prudes.

Lewis Wetzel said...

It just occurred to me that the reason why the DSM classed homosexuality as a mental disorder for so many years was because homosexuality is associated with a long list of pathologies. Greater chance of diabetes, greater chance of morbid obesity, greater chance of alcohol or drug addiction, etc..
Homosexuality -- banned! But for progressive reasons. While in the old days only homosexual acts were illegal, we will have to make being a homo illegal in itself. I'm afraid you won't get the religious types onboard for this, R&B. Those troglodytes still believe that homosexuality is a choice. They aren't progressive enough to believe that orientation is set at birth.

Michael K said...

Machine, tax seminars are concerned with reality and the planning for it. They have nothing to do with morals or the law.

We all pretty much expected the Roberts court to faint in the glare of White House anger.

After all, Roberts rewrote the law before.

Remember,if you will, that Louis XVI dismissed Necker several times before the Revolution got started. They had chances to do the right thing. We do too.

Lewis Wetzel said...

And now, today's episode of Ritmo Hospital . . .
Old man: Help! Help! I'm being murdered! Help!
Doctor Gleason: Quiet down! I'm not murdering you! I'm euthanizing you!
Old man: What's happening? I feel so cold!
Doctor Gleason: Hold still! If I do five more like you today, I get to prescribe a heart operation for an illegal immigrant kid.
Old man: But you can't do this to me! I'm a Democrat!
Doctor Gleason: Our records show you had a rewards card at Dairy Queen! Selfish bastard! I NEED AN ORDERLY HERE!

hombre said...

Terry doubles down. (8:23, 8:33)

Ritmo remains to be seen.

hombre said...

Triples down. (9:46)

Lewis Wetzel said...

You know, I suppose it is an open secret among Democrats -- though perhaps the words are never given voice -- that if you have an "incident", and wake up in the hospital, you would want to find yourself under the care of nurse Sarah Palin (BA communications, University of Idaho) rather than the care of nurse Chelsae Clinton (MA public health, Columbia).

Bleach Drinkers Curing Coronavirus Together said...

Ritmo remains to be seen.

Ritmo had a life and was being attended to in ways that "hombre" isn't "hombre" enough any longer to make possible - in all his glorious decrepitude. But it's nice to know how interested he is in younger men.

There's no need to slice and dice by race on a use tax. Whoever uses, gets taxed. That's how taxes are. That said, the evidence for the contribution of the biggest and most addictive (and most obnoxious) nuisance to nothing other than some common and debilitating health costs is overwhelming. Skin cancer is nowhere near as common (although the ACA's tanning bed tax is logical enough) and if you can find a contribution of cannabis to any significant health cost then tax away.

One would think internalizing negative externalities would appeal to self-styled econ gurus. But I guess the logic of economics is something cons just like to wrap themselves in, as if it were a fancy dress.

If you can find an "anti-freedom" cost to hindering an addiction to the slow poisoning of oneself and all those in the vicinity by way of taxing someone's personal toxic waste dump, then by all means, name your number. But we know what the burden and cost of lung cancer, emphysema and heart disease adds up to, and don't mind having that paid for in advance. You say conservatives squeal "objection!"? Think of it as a personal insurance liability, as anti-collectivist as anything in health insurance is bound to get. But what could conservatives stand for if not the dismissal of trade-offs (as impossible as that is) and pretending that they can have everything in life both ways?

Yes, yes. You want to have your life-size cake and eat it too. We know. So pay for your fucking cake gluttony clean-up care. In advance. Before you stick everyone else with the bill.

hombre said...

Ah, there he is (11:40) in all his straw manning, unintelligible glory pretending to understand the intricacies of the "logic of economics" while imagining that it is conservatives who engage in "fucking cake gluttony."

Is it really conservatives who will suffer as a result of taxing self destructive indulgence? Is it really conservatives who promote "sticking everyone else with the bill?" Any bill?

Quite a stretch, even for Ritmo.

Lewis Wetzel said...

"Yes, yes. You want to have your life-size cake and eat it too. We know. So pay for your fucking cake gluttony clean-up care. In advance. Before you stick everyone else with the bill."
You heard the man, chubby Black folks. Pay up.

Rusty said...

Yes. Yes. The moral scolds love to tax things "for your own good".
Why thank you citizen! I was almost enjoying myself.

Rusty said...

Mark said...
All these conservatives here acting like toddlers being forced to share toys.

The same people who kept saying 'Walker won, deal with it' now show how well they take decisions they don't like. They hypocrisy is deep on Althouse today.


We used to have a constitution, Mark. It was kinda like a framework about how thing were supposed to be done by our government. Apparently we don't do that anymore. Sad, really.
Which begs the question. Just what does our esteemed hostess teach? The law being conditional to the moment and all.
Can there be justice in these circumstances?
I suspect not.

Gahrie said...

Since the text is ambiguous

But the text isn't ambiguous. The majority "found" it to be ambiguous, just like an earlier Court "found" a penumbra that created a new "right".

Court looks at the statute's "broader structure" for meaning, and the need to prevent the "death spiral" determines the outcome.

Why is their a need to prevent a death spiral? At the very least isn't that begging the question?

This decision highlights the two biggest problems that Conservatives have with the Supreme Court. First they dismiss the plain meaning of the words as written. Once you have done that, the rule of law is meaningless, because the written law has no meaning. Secondly the Court sees itself as a legislator, needing to amend a law to produce an outcome. The court clearly has it's thumb on the scale and a see through blindfold.

Todd said...

garage mahal said...
That ass fucking has been delayed because they Dems know it will be an ass fucking.

Well, Republicans have a backup plan and will reveal it right before 2016 and victory will be theirs. Super Top Secret Plan. Haha. Just kidding. How does the latest ObamaCare loss taste?

6/25/15, 2:51 PM


One of the saddest things about all of this is the people like garage that actually think this is a victory. The fact that this is like a umpire at a game making an obviously wrong call to favor the home team that ALSO changes the game rules for all future games is what escapes him (and them). This new power to not take a law at is actual wording but instead to be able to magically morph it into something else instead of simply ruling on whether "as written" it is legal is something that WILL come back to bit you.

When everyone follows the rules, you win some and you lose some but when the administration and the courts decide to change the rules, those changes can be used by your opponents against you in the future. This typically spirals out of control and leads to chaos. The fact that this fill you (and those that are like minded) with such joy is sickening.

Matt Sablan said...

Todd: That's because they're banking on the good odds that Republicans will never quite twist the rules in the way they've had them twisted against them. I mean, look at what we've done with Congress. Instead of completely destroying Democrats, we've made multiple compromises with me. Instead of treating them the way they had treated Republicans, we have opened the floor and listened to them. Worked with them.

They're doing the smart thing: They know Republicans will never pick up the armory of tools that they've laid out as legitimate weapons [just like they know Republicans will rarely boycott, engage in nuisance lawsuits, harass and threaten speakers to get them vetoed from campus, etc., etc.], so why not claim these tools your opponents won't use are legitimate, fine tools?

roesch/voltaire said...

"we must do our best bearing in mind the fundamental canon of statutory construction that the words of a statue must be read in place in the overall statutory scheme" say Justice Scalia, and so this frivolous case, which should have been heard in the first place, meets the reality check of what was the intention of this law. And the three conservative descents reveal just what ideological activists they are.

Todd said...

roesch/voltaire said...
"we must do our best bearing in mind the fundamental canon of statutory construction that the words of a statue must be read in place in the overall statutory scheme" say Justice Scalia, and so this frivolous case, which should have been heard in the first place, meets the reality check of what was the intention of this law. And the three conservative descents reveal just what ideological activists they are.

6/26/15, 11:07 AM


What? So that plan meaning of a sentence does not in point of fact, mean what the words written mean? It means what it means in the larger context of the overall document?

If that were so then they absolutely ruled wrong on this one as not only did the text say "a exchange setup but the state" but every Demo pol and every involved policy wonk specifically said that if states want their citizens to get the credits, they need to setup their own exchanges.

Instead these persons divined what the legislature "really" meant verses what the plan language of the law (haha) and the authors said it meant.

Some legal system you go there.

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