Two Years On: Obamacare

da man · Mar 27, 2012

Zeke12 said:

RickStain said:

Zeke12 said:

Everyone will die.

That means those not lucky enough to get shot or hit by a bus and die instantly will need extraordinary health care -- more than just immunization and the occasional antibiotic scrip.

You seem to be deliberately "not getting" that.
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Because it's false.

Not everyone will rack up the kind of extraordinary health costs that only insurance can pay for. Not even the majority will.
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Well, you're just wrong on the facts.

It's damned expensive to die. It's a nightmare to be chronically ill before you go. But it's still more than most Americans could afford out of pocket to simply die.

I suspect you know this.
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But is the cost greater than the amount they'll have paid in insurance premiums their entire life?

Zeke12 · Mar 27, 2012

da man said:

Zeke12 said:

RickStain said:

Zeke12 said:

Everyone will die.

That means those not lucky enough to get shot or hit by a bus and die instantly will need extraordinary health care -- more than just immunization and the occasional antibiotic scrip.

You seem to be deliberately "not getting" that.
Click to expand...

Because it's false.

Not everyone will rack up the kind of extraordinary health costs that only insurance can pay for. Not even the majority will.
Click to expand...

Well, you're just wrong on the facts.

It's damned expensive to die. It's a nightmare to be chronically ill before you go. But it's still more than most Americans could afford out of pocket to simply die.

I suspect you know this.
Click to expand...

But is the cost greater than the amount they'll have paid in insurance premiums their entire life?
Click to expand...

I'd be hard pressed to think of a question more beside the point, but the answer is it would depend on the person.

Zeke12 · Mar 27, 2012

The latest Medicare data I can find shows that the last six months of the average patients' life -- unadjusted, here, so FWIW -- cost $40,000 in 2007 -- and that number has likely gone, much, much higher since then.

I'd be shocked if it wasn't over $60K.

The median income in the United States in 2007 was $31,111.

da man · Mar 27, 2012

Zeke12 said:

da man said:

Zeke12 said:

RickStain said:

Zeke12 said:

Everyone will die.

That means those not lucky enough to get shot or hit by a bus and die instantly will need extraordinary health care -- more than just immunization and the occasional antibiotic scrip.

You seem to be deliberately "not getting" that.
Click to expand...

Because it's false.

Not everyone will rack up the kind of extraordinary health costs that only insurance can pay for. Not even the majority will.
Click to expand...

Well, you're just wrong on the facts.

It's damned expensive to die. It's a nightmare to be chronically ill before you go. But it's still more than most Americans could afford out of pocket to simply die.

I suspect you know this.
Click to expand...

But is the cost greater than the amount they'll have paid in insurance premiums their entire life?
Click to expand...

I'd be hard pressed to think of a question more beside the point, but the answer is it would depend on the person.
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That is the point. The concept is that everyone needs it, so you're just paying for it in advance. Rick's point is that most people pay far more for the insurance than they will ever get back in benefits for their health care.

RickStain said:

Zeke12 said:

You won't be completely healthy. That's why you're missing the distinction. Man is mortal.
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You don't need health insurance to pay for ordinary health care. That's the way many people use their health insurance these days, but it's certainly not a universal need.

It's a little bit of a semantic bait-and-switch.

There's ordinary health care and there's extraordinary health care. You only need insurance to pay for the latter, but everyone will need the former.

The "everyone needs it" argument hinges on trying to conflate the two.

The majority of people could afford every cent of health care they will use in their lives, with room to spare, in the cost of the premiums they pay. They don't need insurance. A few people will rack up catastrophic costs, and they do need insurance. Everyone buys insurance because we don't know which of us will be in the latter category, but that doesn't meant that everyone will eventually use it.
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Zeke12 · Mar 27, 2012

The concept is not that you're paying for it in advance.

The concept is that if you choose to go without insurance, everyone who has insurance bears the cost of the risk you are taking, and since the government ultimately bears that cost, they're within their rights to regulate the market by forcing everyone to carry some sort of baseline coverage.

The Big Ragu · Mar 27, 2012

I just read the transcript from today, and based on the grilling and the answers, I think this is going to go down 5-4 based on the commerce clause--or the fact that mandating something and then calling it commerce can give Congress the power to force people to do anything. Roberts uses the term, "all bets are off" several times.

RickStain · Mar 27, 2012

Zeke12 said:

The concept is not that you're paying for it in advance.

The concept is that if you choose to go without insurance, everyone who has insurance bears the cost of the risk you are taking, and since the government ultimately bears that cost, they're within their rights to regulate the market by forcing everyone to carry some sort of baseline coverage.
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The government chose to bear that cost. It doesn't get to claim more sweeping powers because of that choice.

RickStain · Mar 27, 2012

The Big Ragu said:

I just read the transcript from today, and based on the grilling and the answers, I think this is going to go down 5-4 based on the commerce clause. Roberts uses the term, "all bets are off" several times.
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My impression is the opposite: Upheld 5-4 with Kennedy the swing vote, with a very narrow decision that tries to do the Bush v. Gore "This decision only applies to this and nothing else in the future" mealy-mouthiness.

Either way, I'm taking my "told you so" to everyone who said this was a Constitutionally easy case.

Zeke12 · Mar 27, 2012

The Big Ragu said:

I just read the transcript from today, and based on the grilling and the answers, I think this is going to go down 5-4 based on the commerce clause--or the fact that mandating something and then calling it commerce can give Congress the power to force people to do anything. Roberts uses the term, "all bets are off" several times.
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I think that's a fair read off the oral arguments -- but the oral arguments only.

The things to watch are how does Scalia get around his previous opinion if he doesn't vote to uphold, and how much of a motivation Roberts has to be in the majority.

RickStain · Mar 27, 2012

Zeke12 said:

The latest Medicare data I can find shows that the last six months of the average patients' life -- unadjusted, here, so FWIW -- cost $40,000 in 2007 -- and that number has likely gone, much, much higher since then.
Click to expand...

What kind of average are we talking about here? Median? Mean? Mode?

The Big Ragu · Mar 27, 2012

RickStain said:

The Big Ragu said:

I just read the transcript from today, and based on the grilling and the answers, I think this is going to go down 5-4 based on the commerce clause. Roberts uses the term, "all bets are off" several times.
Click to expand...

My impression is the opposite: Upheld 5-4 with Kennedy the swing vote, with a very narrow decision that tries to do the Bush v. Gore "This decision only applies to this and nothing else in the future" mealy-mouthiness.

Either way, I'm taking my "told you so" to everyone who said this was a Constitutionally easy case.
Click to expand...

Kennedy was kind of skeptical.

His first question -- and he repeated it -- was "Can Congress create commerce in order to regulate it?"

He didn't quite wear his vote on his sleeve, but he did say he was skeptical, and then said, "Assume for the moment that this is unprecedented, this is a step beyond what our cases have allowed, the affirmative duty to act to go into commerce. If that is so, do you not have a heavy burden of justification?"

He said that what they were asking for changes the "relation of the individual to the government in a "unique way" and then suggested that they had a "heavy burden of justification to show authorization under the Constitution."

Now, that might be a set up to then say that they provided the justification. But he was pretty hard and the answers -- with Scalia's questions peppered in -- weren't sounding very convincing.

RickStain · Mar 27, 2012

My impression was just what you said: He was trying to draw out a justification, because in the end that's where he's going to fall.

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Two Years On: Obamacare

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