Obamacare ruling: WOW, talk about a lack of perspective!

There’s some big news out of a federal appeals court in D.C., and I am just stunned by the lack of perspective in the way The Washington Post is reporting it:

federal appeals court panel in the District struck down a major part of the 2010 health-care law Tuesday, ruling that the tax subsidies that are central to the program may not be provided in at least half of the states.

The ruling, if upheld, could potentially be more damaging to the law than last month’s Supreme Court decision on contraceptives. [emphasis mine]

The three-judge panel of the D.C. Circuit Court of Appeals sided with plaintiffs who argued that the language of the law barred the government from giving subsidies to people in states that chose not to set up their own insurance marketplaces. Twenty-seven states, most with Republican leaders who oppose the law, decided against setting up marketplaces, and another nine states partially opted out…..

Wow. Do ya think?

This ruling, “if upheld,” would mean Obamacare would cease to exist for those of us in South Carolina and in 26 other states. There would be nothing left of it. We don’t have the Medicaid expansion, and we don’t have a state exchange, so this would be it — no one — South Carolina would be getting health insurance through the ACA.

Which, of course, is precisely what Nikki Haley and all those other SC Republicans who hate Barack Obama and all he stands for far, FAR more than they care about the people of SC want. Their dream, our nightmare, would be achieved — South Carolina would have “opted out” of health care reform.

Compare that to a ruling that closely-held corporations with religious objections would not have to cover some contraceptives — while covering EVERYTHING ELSE that a person would go to a doctor for.

So, uh, yeah, it could “potentially” (that hedge word is just the cherry on top of this monument to lack of perspective) be more damaging to the law.

Wow. Wow…

I’ll get mad at Nikki Haley and her fellow ideologues who put South Carolina in a position to be denied any benefit (any benefit at all, people, not just your preferred contraceptives, or your favorite antihistamines, or your chosen brand of bandages) from the ACA later. Right now, my mind is too boggled by that observation from the WashPost

I don’t know anything about this Sandhya Somashekhar person who wrote the piece, but does she not have an editor?!?!?

88 thoughts on “Obamacare ruling: WOW, talk about a lack of perspective!

  1. Brad Warthen Post author

    If I weren’t so busy reeling from that horribly-written news story, I’d fulminate about this statement from the White House:

    “You don’t need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace,” said Josh Earnest, the White House press secretary. “I think that is a pretty clear intent of the congressional law.”

    After that moronic populist phrase — “You don’t need a fancy legal degree to understand…” — which brings to mind the kind of know-nothing, anti-intellectual rhetoric of those abominable anti-Sheheen ads from the RGA, I find it hard to bring myself to read the rest of the statement…

    1. Brad Warthen Post author

      You’ll note that the NYT story doesn’t mention the Hobby Lobby ruling, for the simple reason that this has nothing to do with the Hobby Lobby ruling. The two things don’t exist in the same conceptual universe…

  2. Doug Ross

    “and we don’t have a state exchange, so this would be it — no one — South Carolina would be getting health insurance through the ACA.”

    Is that really a true statement? The ruling only dealt with subsidies, didn’t it? Access to insurance would not go away, only having rich people pay for it for those states that did not implement an exchange.

    A badly written bill poorly implemented SHOULD fail.

    1. Bryan Caskey

      Yeah, I think Brad is wrong there. First, the holding won’t be implemented as the court knows it will be reviewed. So nothing happens for now.

      Even if it WERE implemented, it would mean no subsidies. Everyone on a federal exchange would pay true cost of policy.

      Also, 4th Circuit just reached opposing holding, so we officially have a circuit split.

      Justice Roberts to the White Courtesy Phone please…

    2. Brad Warthen Post author

      Gentlemen, allow me to point out that you are being — totally unintentionally, I am sure — obtuse.

      The point of the ACA is to make sure people who can’t get affordable health insurance can get affordable health insurance. The MEANS for making this health insurance offered through the exchanges AFFORDABLE is the SUBSIDIES.

      Without the subsidies, the only people getting insurance through the exchanges would be people who could have afforded private insurance WITHOUT the exchanges.

      The subsidies are the element that extends insurance to people who would not have it without the ACA. Without them, the ACA accomplishes nothing, beyond some peripheral things such as helping people with pre-existing conditions and allowing kids to stay on parents’ insurance.

      1. Brad Warthen Post author

        OK, bad word choice. The pre-existing conditions and kids-staying-on-insurance provisions are important, so I should say “peripheral” (that’s a word better saved for what the Hobby Lobby decision dealt with).

        But they are not CORE to the very existence of extending insurance to people who can’t afford it now. They are not essential to the first word in the name of the act…

      2. Bryan Caskey

        I’m just being precise. But you’re right in a general sense. If there are no subsidies on the federal exchange the effect of the ACA will be diminished.

        Don’t blame me. I didn’t write the law. Statutory construction is what it is.

      3. Silence

        Not obtuse. There’s simply no way that a society can produce as much of a good as can be consumed, if it’s given away for free, or at a vastly reduced cost. ACA is designed to fail, which it is rapidly doing. When it fails, it’s designed to take the rest of the healthcare delivery system down with it and usher in a new era of rationed care and a single-payer NHS-style system.

        1. Doug Ross

          Yes… look at all the proposed rate increases that insurance companies have applied for next year. Double digit increases everywhere. Affordable? Not a chance.

          Nobody should get a subsidy if they have cable TV.

          1. Brad Warthen Post author

            How do you define cable TV? For instance, I get a sub-minimal form that the don’t even advertise, below basic cable — I just get the local broadcast channels.

            Is that enough to pass a death sentence on me?

            Seriously, individual health insurance can cost in a month what cable TV costs in a year. So a person who can’t afford health insurance on his own should be denied the right to spend far less on cable? Really?

            1. Doug Ross

              If someone can afford to pay for television instead of their own healthcare, that’s a choice they should be allowed to make. Food, shelter, healthcare, transportation should be addressed in a personal budget before entertainment.

              I’m not sentencing people to death, just to personal responsibility.

            2. Doug Ross

              And individual health plans are about the cost of a cable bill/internet/cellphone bill for the year (nevermind the $600 iphone, $800 television, and $400 laptop).

              People make choices. Some people choose to have others pay for their healthcare.

            3. Brad Warthen Post author

              For someone to be “paying for television instead of their own healthcare,” the amount they’re paying for cable would have to be enough to pay for healthcare.

              Doug, when I was having to pay my whole insurance bill through COBRA when I lost my group insurance, it was somewhere between $1,200 and $1,500 a month.

              That’s some cable package you’ve got if it costs anywhere near that…

            4. Silence

              Brad, why would you pay TWC or AT&T even a modest monthly subscription fee for something that is broadcast, in 720p high definition, over the airwaves… FOR FREE? I have a device called an “antenna” that allows me to watch all the local TV I want, at no charge. I actually don’t use it, but I do keep it around just in case there’s an outage, or in case of civil disturbances. Just so I can get the civil defense instructions or whatever.

              Seriously though, paying good money for over-the-air broadcast channels is about ridiculous. It’s like supporting Obamacare ridiculous. It’s that bad.

            5. Doug Ross

              So you were talking about family coverage? I looked on the Obamacare site last fall and for a single male, it was around 400 a month fire a bronze plan. That’s in the ballpark for directv, Verizon cellphone, and tune Warner internet..

              Even if it is less, should someone else pay for your healthcare if it’s not a priority for you?

          2. Harry Harris

            Proposed. That’s what they are. Subject to review. In addition, if you’d ever been in the individual healthcare market, (as I was for 35 years) you’d know that double-digit increases were the usual fare prior to 2012. I also doubt if you’ve ever paid for your own health care as you allude in your reply below.

            1. Doug Ross

              You mean my employer paid benefit healthcare that I had all my working career and was extremely happy with? The type of plans that most American workers have and were happy with?

              I spent a significant amount of time last fall trying to price shop on the Obamacare website for a plan. It was extremely painful when it finally worked. I know what plans cost.’

        2. scout

          I think it’s too soon to tell if it is failing. I’ve heard some reports about the effect of incentives that encourage the development of proactive programs to manage health concerns before they become a problem rather than treating them expensively after the fact that are promising and directly related to the changes brought about by the law. I think it is a given that any kind of transition so monumental may be clunky or have kinks that need to be worked out and to judge ultimate success too soon in the transition could be misleading.

  3. Harry Harris

    Unboggle your mind, Brad. It’s not unusual for a mainstream journalist to use understated and hedged language in either a news or opinion piece. If she had used “moronic” and “know nothing” in her article as you did in your comments would it give perspective to her piece? The lack of perspective that “stuns” me is headlining a wishy-washy journalist’s writing as opposed to highlighting the outrageousness of the ruling itself. We all know the reason for most of this legal wrangling and state-level stonewalling. It is intended to destroy the ACA by any means available – regardless of the consequences to citizens, our medical care system, or the fabric of our society (they destroyed community long ago).

    1. Brad Warthen Post author

      I’m an editor. Stuff like that stops me cold. It makes me feel like my head is going to explode. I feel the need to DO something about it. I can’t call the reporter over and, um, explain the problem to her, so I erupt on you nice folks…

      The fundamental problem isn’t the hedging language. As I said, that’s just the cherry on top. The fundamental problem is that the paragraph has NO reason to be there, at all. It adds no understanding to this really important story. And it’s an addendum to the LEDE. It’s interrupting the most important part of the story, where people get their first sense of what’s going on…

      1. Brad Warthen Post author

        A large part of my outrage over the insertion of that graf at the top of the story arises from the fact that it arises from an editorial viewpoint.

        Only a person who believes that the Hobby Lobby dealt some sort of heavy, core blow to the entitlements of people covered by health insurance under the ACA — and believes that there is NO OTHER WAY that anyone can look at it, making that attitude noncontroversial — could have seen the need to include that thought in the story.

        That’s an attitude I expect to be expressed by someone who writes “War on Women” appeals for donations for the Democratic Party, not a news reporter.

        This is exactly the kind of thing that undermines readers’ faith in the news that they read, and causes people to yammer about “bias” in the news.

        The reporter can say, truthfully, “I didn’t express an opinion; what I said was factual — it is true that this (“potentially!”) could have a greater effect on the ACA than the Hobby Lobby ruling.”

        But it wouldn’t occur to anyone who didn’t have such an editorial opinion to include such an observation. This signals a certain worldview to the alert reader…

  4. Brad Warthen Post author

    MEANWHILE, the historically conservative 4th Circuit unanimously rules the OPPOSITE way on the same issue:

    The United States Court of Appeals for the Fourth Circuit, in Richmond, upheld the subsidies, saying that a rule issued by the Internal Revenue Service was “a permissible exercise of the agency’s discretion.”

    That ruling came right after the first one… And so:

    The courts’ decisions are the not the last word, however, as other courts are weighing the same issue. And the Washington panel’s ruling could be reviewed by the full appeals court here.

  5. Bart

    Republicans and conservatives or at least some conservatives and Republicans will be overjoyed at the ruling. Why not simply admit that ACA as it was rolled out was doomed to failure and not simply because it is Obama’s signature legislation but because it was one of the worst examples of a conglomeration of loosely connected, ill-conceived, and poorly executed bills and wish lists I can recall. It had no actual design in place that would allow it to succeed from day one. No one is denying something needed to be done and if the administration had handled it in a different manner instead of allowing Nancy Pelosi to define it when she said, “we need to pass it to find out what is in it”, it may have had a decent chance to succeed. That is one of the most asinine comments made by a congressional leader I have ever heard.

    Doug and probably Silence can attest to the fact that a very bad system will not operate and produce the results the administration and congress promised. There was too much opposition from the beginning and instead of giving it another year or two to work out the bugs and make sure all aspects of the bill would pass legal muster, the administration couldn’t resist playing the one-upmanship game and pushing it through before it was ready.

    This Gordian’s Knot will have to be trimmed back to a bare thread and someone with some damn common sense and the ability to plan beyond the next fund raiser will have to step in and repair the damage ACA has created, not because reform was not needed but because it is impossible for a Rube Goldberg bill to actually work and serve the purpose it was intended for.

    While Brad is outraged, I am not because maybe, just maybe, some grown-ups will take over and come up with a health care reform package that actually works for everyone. As much as I may not agree with single payer, if administered properly and if the insurance companies are not at the helm along with hospitals, it may be the best solution in the end.

    1. Doug Ross

      Give everyone vouchers and let the market sort out the system. You want a plan with birth control, buy it.

      All Obamacare had to do was implement rules related to access. Not cost, not “free” services, not mandates.

      If they had just done that first, we wouldn’t be in the mess we are in.

            1. Doug Ross

              Would you say that food stamps (EBT cards) have caused the price of the food to rise?

            2. Silence

              Yes, Doug. The program was originally conceived as a way to reduce food surpluses of certain commodities, in part. Why do you think it’s under the Department of Agriculture? If it were just about feeding hungry people it would be part of Social Services. So yes, it’s a price support.

      1. scout

        I think there is a good body of thought that says free markets don’t work well for healthcare for several reasons –
        1) consumers don’t have the expertise to evaluate their choices – even if they shop around doctors, they are likely to end up making decisions based on things like bedside manner rather than the doctor’s actual medical skill because they don’t have the knowledge to evaluate that.
        2) People don’t usually price shop among doctors or procedures since they usually are just responsible for the deductible anyway. Information to comparison shop if you wanted to is not readily available.
        3) People don’t usually feel like they can say no – if they need the care.
        4) Taken to extremes, as long as healthcare is a profit based business, it is technically in the interest of healthcare providers to not get you healthy.

        However, as much as this is true, some of the changes put in place by the ACA go in the direction of working against these forces, even though the ACA is still a market based system. It is a market that has not yet come to equilibrium. It is too soon to know he effects of the changes on the system.

        1. Silence

          1) You are correct, consumers do not have the knowledge to evaluate their choices properly. This applies both to physicians as well as to procedures. Let me come back to this one at the end.

          2) People don’t price shop amongst doctors because typically they are only responsible for the copay/coinsurance/deductible – as you say. This is an example of market forces being distorted. If your responsibility is capped at $20/visit, or $2500/year – naturally you want the best, you want all of it, and you want it this year instead of next since you’ve already hit your deductible. It’s been a while since the “free market” has been done, here. We are much less cautious when spending other people’s money.

          3) People don’t feel like they can say “no” – that is true. We’ll pay up to our last dollar to extend our lives. Economically, that makes sense. It is especially true that we won’t say “no” if someone else is paying. Say my car gets hit in a parking lot, just a minor wreck – if the other guy’s insurance is paying, I’m gonna get it fixed, and fixed RIGHT. I’m gonna take it to the dealership and have them make sure that everything potentially related to the accident gets fixed. Let’s say that I come back to my wrecked car and the culprit has split the scene – now it’s up to me to pay for the repair. Maybe I don’t want to report it to my insurance, or maybe I have a high deductible. I’m going to make a decision about whether it’s worth it to me to have the repair done. Maybe I’ll just live with it for a while, or maybe I’ll have any structural/mechanical damage fixed, and just leave the cosmetic stuff as is. The difference is in who’s paying.

          4) It is always in the interest of a service provider to have you as a repeat customer. Doctors, Big Pharma, Regal Cinemas, whomever. That can be either an advantage, or a disadvantage. In a truly competitive environment, people will be free to migrate to whomever provides the best service – including curing you rather than just treating your symptoms.

          Back to point 1 – The one area of “medicine” where market forces really are at play is in elective procedures, like cosmetic surgery. It’s a cash business and people do research to compare prices and quality of outcomes. Real prices have actually fallen over the last 20 years, while demand is way up. Granted, you don’t always know when a triple-bypass is coming, or have a lof of time to plan a course of chemotherapy, but the market does work, if tried.

    2. Brad Warthen Post author

      Flawed as it is, there’s no way the ACA was “doomed to failure.” Bryan and others think the anti-ACA ruling was inevitable. The dissenting judge, and all three judges in the 4th Circuit, disagree:

      Judge Edwards said that the Obama administration’s reading of the law, considered in “the broader context of the statute as a whole,” was “permissible and reasonable, and, therefore, entitled to deference.”

      A similar approach was sounded later by the Fourth Circuit panel, which said, “We find that the applicable statutory language is ambiguous and subject to multiple interpretations.” The court said it would therefore give deference to the reading of the law by the Internal Revenue Service, which issued the rule allowing payment of subsidies for people in all states, regardless of whether the state had a federal or state exchange.

      1. Bryan Caskey

        “Bryan and others think the anti-ACA ruling was inevitable.”

        Whoa, whoa, whoa! Stop. I have never said that any ruling by any court is “inevitable” because that’s a ludicrous statement. Anyone who says they guarantee what a court will do, or that any ruling is inevitable is not to be taken seriously. I’ve been litigating stuff long enough to know that nothing is guaranteed or inevitable, regardless of the facts or law.

        First I’m obtuse, and now I’m just having words put in my mouth. (Where’s the editor around here?)

        Having said that, I would side with the statutory construction analysis of: “in interpreting a statute, a court should always turn first to one cardinal cannon before all others. We have stated time and again that courts must presume that a legislature says in a statute what it means and means in a statute what it says there.”

        The 4th circuit opinion is pretty wishy-washy. I can’t do much analysis here in detail for logistical reasons, but I would encourage y’all to go read it. It’s not a ringing endorsement of the ACA.

        Also, this is a good time to remind everyone of what “judicial activism” is. Quite simply, judicial activism is exceeding the plain text for a desired policy result – which is what the 4th circuit basically did, and it’s exactly what the dissent from the DC circuit advocates.

    3. Mark Stewart


      Nothing succeeds “from day one”. Everything is a work in progress.

      This is progress. You may not like it and it may scare you; but it is better than what was before. As you said; we are traveling through an imperfect present. And it has always ever been thus.

  6. Norm Ivey

    This is from an opinion piece at WaPo from July 9th:

    “The Affordable Care Act was meant to “provide affordable . . . coverage choices for all Americans.” A key section says, “Each state shall . . . establish an . . . Exchange,” but another section provides that if a state “elects” not to establish the “required Exchange,” the secretary of health and human services must “establish and operate such Exchange.” These sections both require states to establish exchanges and allow them not to do so.

    Congress gave the IRS the responsibility to resolve such contradictions, and the IRS adopted the only reasonable approach. If a state does not create the “required Exchange,” HHS steps into its shoes and sets up “such Exchange.” The law, in other words, requires the federal government to create the “Exchange established by the state,” with the same authorities and responsibilities as state exchanges, including offering premium tax credits.”

    So if a state doesn’t do what the law says to do, then HHS must do it in its stead with the same criteria. I think today’s ruling gets shot down by SCOTUS.

    1. Doug Ross

      Let’s consider for a moment why the Internal Revenue Service should be involved in the healthcare system in any way, shape, or form. They shouldn’t. Just as there shouldn’t be tax free health care savings accounts nor deductions for medical expenses.

      Liberals rail on and on about “corporations staying out of my healthcare decisions” yet are apparently totally fine with the IRS being involved.

      1. bud

        Actually Doug we liberals want a single payer system like most other countries in the world have looooong had. There would be no need for the IRS OR corporations to be involved. I haven’t seen any arguments to suggest the IRS is involved in Medicare.

        This has always been a pretty simple issue with a Rube Goldberg solution. The US pays far more for healthcare than anyone else and has poorer outcomes than most developed countries. Even the wait time issue is phony. Only the Canadians have longer wait times yet that is the country everyone points to on that aspect of healthcare.

        With Obamacare finally working the naysayers continue to try and undermine it. Of course this includes the very activist courts. If one more conservative ever mentions liberal activism in the courts they should be laughed at for their rank hypocrisy.

        As for the IRS vs corporations I’d take the IRS over the dreaded plutocracy any day. We saw the carnage that resulted when there was no government guidelines when it comes to what is covered and what isn’t. Do we really want to go back to the bad ole days of corporate greed driving the costs of healthcare higher and higher and level of service lower and lower? No rational person would even consider such a horror.

        1. Silence

          Pay more for healthcare with worse outcomes? That’s simply not true.
          “the heart disease mortality rate in England was 36 percent higher than that in the U.S.”

          “The BBC subsequently discovered that many patients initially assessed as needing surgery were later re-categorized by the hospital so that they could be removed from waiting lists to distort the already unconscionable delays”

          “Comparing data for cancer, heart disease, and stroke, the most common sources of sickness and death in the U.S. and Europe, and the diseases that generate the highest medical expenditures, we see the overt failure of the NHS and its socialist relatives….
          the breast cancer mortality rate is 88 percent higher in the United Kingdom than in the U.S.; prostate cancer mortality rates are strikingly worse in the UK than in the U.S.; mortality rate for colorectal cancer among British men and women is about 40 percent higher than in the U.S.”
          Source: http://www.forbes.com/sites/scottatlas/2013/07/05/happy-birthday-to-great-britains-increasingly-scandalous-national-health-service/

          1. Harry Harris

            Forbes.com. As in Steve Forbes? The Forbes.com publisher that publihes anti-government pieces daily? Great source.

            1. Doug Ross

              It was referencing a BBC report… you know, the public service broadcasting entity funded by the government through taxes…

        2. Bryan Caskey

          “As for the IRS vs corporations I’d take the IRS over the dreaded plutocracy any day.”

          What makes the people working for the government altruistic angels who are above self-interest and fallibility, while people working in non-government jobs are greedy plutocrats motivated purely from self-interest?

          I find your skepticism of people’s motives does not carry over into people who happen to work in the public sector.

          “With Obamacare finally working the naysayers continue to try and undermine it. Of course this includes the very activist courts.”

          Huh? What’s your definition of an “activist court”? I thought you would have been pleased that the ACA law was upheld by the DC Circuit that proclaimed the written letter of the law is binding. Everyone keeps saying that the DC Circuit “struck down” part of the ACA. In fact, they did the opposite. They affirmed that the law says what it says.

  7. Bart

    I think it might be a good idea for everyone to listen to Jonathan Turley’s comments to a congressional committee recently. Surprisingly, he is in favor of the lawsuit brought against Obama and he addresses ACA and other issues where Obama has decided to “go it alone”. Any recap I would present would pale in comparison to the actual testimony he gave.

    The link is: http://social.newsinc.com/media/json/69017/26417117/singleVideoOG.html?type=VideoPlayer%2F16x9&videoId=26417117

    Over the past 20 plus years, our presidents have started to use their executive powers to bypass congress and as Turley pointed out, when Obama stated he would go it alone, Democrats stood in unison and applauded him for taking action that would in reality, weaken their own constitutional powers and responsibility. Willingly abdicate their responsibility to the voters and voluntarily place more power in the president’s hands.

    Listen to his words and decide for yourself.

  8. Doug Ross

    Today’s news of Obamacare incompetence:


    “WASHINGTON (AP) — Undercover investigators using fake identities were able to secure taxpayer-subsidized health insurance under President Barack Obama’s health care law.The weak link in the system seemed to be call centers that handled applications for thousands of consumers unable to get through online. The nonpartisan Government Accountability Office was to tell a House committee on Wednesday that its investigators were able to get subsidized health care under fake names in 11 out of 18 attempts. The GAO is still paying premiums for the policies, even as the Obama administration attempts to verify phony documentation. Those additional checks appeared to need tightening; the GAO said parts of the fake documentation it submitted for two applications actually got verified.”

    1. bud

      Doug the difference between you and me on this issue is pretty simple. These kinds of fraud issues like you cited aren’t really not a problem for me. If relatively wealthy people fraudulently get a subsidy for their health insurance so what? If it were up to me no one would have to prove they are poor to get cheap insurance. That would just be part of being an American.

      A vastly bigger problem to me are those tax loopholes that allow the rich to pay low taxes and shelter income abroad.

      1. Doug Ross

        Bud – there is a difference between “cheap” and “someone else paying for it”. I’d love to have a cheap car but I’d be much happier if someone else paid for it.

        This is about incompetence in implementing a system. It’s not about the subsidies.

        I read an article yesterday about a guy from South Carolina who lost his employer based insurance in May and has been trying since then to get a policy through the federal exchange with no luck due to system issues and nobody knowing how to resolve them.

        The implementation has been a total disaster.

        1. Brad Warthen Post author

          Doug, this observation:

          Bud – there is a difference between “cheap” and “someone else paying for it”. I’d love to have a cheap car but I’d be much happier if someone else paid for it.

          … shows a lack of understanding of how it works.

          People getting subsidies are paying for insurance. At least some are; I don’t know what percentage. They’re just not paying the full price. So if you wanted to do a car analogy, it’s more like getting a rebate, or getting the car on sale, or having a transportation allowance from your employer pay part of the price…

          1. Doug Ross

            When you get a rebate, where is the money coming from? It’s the manufacturer dropping his price.

            When you get a subsidy, where is the money coming from? Someone else paying a portion of your bill. The price is still the same from the insurance company.

            A subsidy is like asking your friend to loan you $4000 to buy a car and then not paying him back. And resenting him for even having $4000 in the first place.

            1. bud

              Doug you and I see this so very differently that I’m sure we’ll never agree on what needs to be done. But at least focus on where I’m coming from. I see publicly subsidized healthcare as a public good that benefits everyone. If I pay a bit more in taxes so that my adult children can stay on my ex wife’s health insurance a while longer that is a huge benefit to me. And once they are either insured or reach age 26 and I no longer receive that benefit then my taxes will pay for someone else’s children. And I’m fine with that. If other people have healthy adult children isn’t that ultimately beneficial to every taxpaying citizen? Simply put it is completely obvious to be that health care is to some extent a public good in the same way that highways and the military are. For every dollar I pay I receive much more than a dollar in benefits. If you don’t believe that’s true then you’ll never see where I’m coming from. It’s kind of like arguing about the color of the sky. If you see it as some other color than blue during a cloudless day at noon then nothing I can say will persuade you otherwise.

            2. Silence

              bud – my arguement would be that taxpayers can never afford to produce/purchase as much healthcare as we can consume. Having a healthy population is certainly in the public interest, though.

            3. Doug Ross


              Unless you make over $250K per year, you are not paying anyone’s subsidies.

              Now if you want a single payer system where EVERYONE pays the same percentage of their income into a system, that’s fine. No Medicare, no Medicaid, no subsidies. One rate for all.

            4. scout

              “bud – my arguement would be that taxpayers can never afford to produce/purchase as much healthcare as we can consume. Having a healthy population is certainly in the public interest, though.”

              This may be true but I still think it is too soon to tell. The changes put in place by the new law have not been in effect long enough for the system to come to an equilibrium. The forces that ACA changes impose to reduce unneeded testing and encouraging preventative care have not had a chance to show results yet. It is too soon to know how effective these will be but it is a move in the right direction.

              If the law is working it becomes more about not how much “we can consume” but how much we need, which is not at all the same thing.

            5. Silence

              scout – of course how much you “need” and how much you consume are two vastly different amounts. I find it interesting that all of a sudden, as Obamacare is being implemented the public begins to hear about how we don’t need certain tests quite as often as we used to be told.
              ie. that annual pap smear/cervical exam
              annual mammogram
              colorectal cancer screening

              I think we are about to get told that our needs aren’t as great as we thought they were, hence they were in fact only wants.

          2. Silence

            87 percent of HealthCare.gov customers are getting taxpayer subsidies to purchase health insurance. According to a report released by the Department of Health and Human Services customers in federally-run Obamacare exchanges that received any amount of subsidies paid on average 76 percent less than the real cost of their premium.

            Taxpayers are paying insurers an average of $246 per month, with Obamacare customers paying an average of $82 per month.

            While subsidies may reduce the amount that a lower-income person/family has to pay for health insurance, they do not affect the actual premium. Premiums reflect the underlying cost of care. Subsidies help make increasing premiums more affordable for lower-income consumers, but they do not actually reduce premiums.

            1. Doug Ross

              And where are the funds for the subsidies coming from primarily? I believe it is a tax on those awful, greedy, lucky people who earn more than $250K a year.

            2. Harry Harris

              Prior to the ACA, premiums on individual policies reflected more than 25% of care. Now they reflect 20%, and don’t deny coverage and don’t easily welsh on paying claims for whatever reason they can find. The waste involved in inflated over-testing, over prescribing, and over-priced procedures is coming down, but still has a way to go to become reasonable.

            3. Silence

              “Prior to the ACA, premiums on individual policies reflected more than 25% of care. Now they reflect 20%” – huh? So, in a non-subsidized individual policy market, were the providers or insurance companies just operating at a loss? I’m not sure I grok what you are saying.

    2. Harry Harris

      I welcome any attempts to find flaws in the system, especially when intended to improve it. It makes little sense for a person to get a subsidized insurance policy for which he pays part of the premium and will likely be unable to use to make back any money. In addition, the finding of weaknesses here will likely cause ways to find and prosecute the fraudsters to be developed.

  9. bud

    I’m fixing to do some hands-on analysis of our healthcare system. In a couple of hours I’ll head to the cardiologist to find out if I need a pacemaker. Seems as though I have a weird heart rhythm. Even with my state gold-level health insurance I’m still spending a considerable amount. Not that I’m complaining. I’m one of the lucky ones. Without good insurance I might have a difficult time even getting the treatment. How do people without insurance manage at all? No wonder US life expectancy continues to decline relative to the rest of the developed world.

    1. Bryan Caskey

      My wife and I are doing some field testing today. We’re over at Palmetto Health Parkridge for her labor and delivery of our second child. She’s got the tough job of actually delivering the baby. I’m just here for moral support. No serious contractions yet; she’s resting comfortably.

      New facility is top-notch. It even has that “new hospital smell”.

      1. Silence

        Parkridge is definitely top-notch. Somebody is paying for it, most likely the families of patients like young Caskey. Best wishes for the new arrival today!

  10. Doug Ross

    In the Democrats proposal for funding to address the children at the border issue they have tacked on a separate request for $225 million for missile-defense aid to Israel.

    Think about that amount when considering what to do about providing health insurance to Americans who can’t afford it.

    $225 million. Proposed by Democrats. For Israel.

  11. bud

    Just got back from the Cardiologist. The bad news for Bryan, Doug, Silence and all the other libertarian/conservatives it looks like I’ll be around to spew outrageous liberal venom for a while longer. Probably no pacemaker for now but I’ll be taking a stress test in a few weeks to get a more thorough assessment.

    1. Doug Ross

      Good news.. I never doubted you had a good heart. Now, if you want to schedule an appointment with a neurologist… 🙂

    2. Bryan Caskey

      Glad you’re doing well, bud. I am happy to report a happy, healthy baby girl! Margaret Lamb Caskey was born at 2:38. 7 lbs. 15 oz. Mom and baby are both doing great!

  12. Bart

    Congratulations Bryan!!! Now the fun begins.

    bud, glad to hear you don’t need a pace maker. I agree with Doug, you do have a good heart and even with all of your liberal vitriol aimed at the best people around, Libertarians and conservatives, I can only wish the best for you and encourage you to take care of your health.

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