Implications of the Impending Obamacare Decision

The Supreme Court's decision on the Patient Protection and Affordable Care Act, aka Obamacare, should be handed down any day now. Whatever its result, the decision will undoubtedly have far-reaching implications for the state and future of American health care. There are several scenarios in play, and all will affect you in one way or another. Let's take a look at the Supreme Court's potential decisions, and what they mean for your health, your finances, and your future.

Option one: The entire act is legal and will be allowed to stand
The immediate implications of Obamacare's constitutionality are complex enough, but long-term consequences could be very difficult to predict. Let's start with what the law offers Americans, in some very broad strokes:

  • Expanded health-care coverage, particularly for higher-risk populations.
  • Tighter and more regulations of the medical insurance and health-care industries.
  • Expanded Medicaid coverage for the poor.
  • Improved health-care efficiency and quality via an oversight board.
  • Health insurance exchanges/marketplaces that will help individuals and small businesses better manage their insurance costs.
  • Mandated health insurance for employees at companies with more than 49 employees, with a tax penalty for companies that don't comply.
  • Greater government effort to control chronic health problems such as obesity.
  • An "individual mandate" that requires most uninsured individuals without extenuating circumstances to purchase insurance or face a tax penalty.

There are wide-reaching effects of nearly every major provision of the law. Insurance companies would have to become more efficient or risk losing their profits. Most major insurers, including UnitedHealth (NYSE: UNH  ) and Wellpoint (NYSE: WLP  ) , already operate within a fairly narrow range of profitability:

UNH Profit Margin Chart

UNH Profit Margin data by YCharts.

The law also makes major changes to the way the government manages the costs of health care. Without some manner of cost controls, many fear that costs could spiral completely out of control, placing a crushing burden on both government programs and individuals. The law restricts what companies across the health-care spectrum can do in pursuit of profit. It also imposes new burdens on larger employers to provide health care to their employees, if they are not already doing so.

Industries seen as potentially detrimental to the public's health, like tanning salons, have new restrictions on their operations. Orange-hued celebrity Snooki from The Jersey Shore made headlines in 2010 when she hooted angrily to the media about new Obamacare-mandated taxes on tanning beds.

Of more pressing concern to you and me, however, is that individual mandate. It's widely seen as both the cornerstone of the law's effectiveness and of its questionable legal status. To better manage insurer risk, the law induces lower-risk individuals who might not often use health care into the insured pool. These low-risk individuals would then, in theory, subsidize the higher-risk individuals who have been granted greater protections. Out-of-pocket premiums would be capped up to 400% of the federal poverty line, and the tax penalty for not buying insurance could amount to $695, or 2.5% of income, by 2016.

Beyond the obvious effects on both corporate and individual pocketbooks, there's great concern that a law mandating that Americans must do something simply because they live in America is troubling for some legal scholars. If the government can force its citizens to enter into contracts with corporations, without any other precondition beyond "being an American," then there may be no effective limitations on the power and reach of that government. Much of this argument rests on the question of whether health insurance is a right or a privilege.

Option two: The individual mandate is excised and the rest is upheld
As I mentioned earlier, the individual mandate is Obamacare's most controversial provision. It's also perhaps its most critical, and leaving the rest of the law intact without the mandate could have devastating consequences for those remaining insured. Since low-risk individuals would have no inducement to join the insurance pool, the remaining higher-risk insured (and even those in good health) could see their premiums skyrocket.

Premiums for those purchasing health care on their own -- not through an employer plan -- could rise by up to 40%, and up to 24 million fewer people might be insured, if the mandate were struck down without changing the rest of the law.

Employers and health insurers would also be caught in a serious bind, forced to insure higher-risk individuals without the benefits of healthier people acting as a sort of subsidy. McDonald's (NYSE: MCD  ) and Wal-Mart (NYSE: WMT  ) , both of which employ many thousands of low-wage workers, are already under pressure from the law's employer requirements, and may simply wind up paying the tax penalties instead of providing coverage.

The mandate is unpopular with the public. However, polls are mixed as to what its fate should be. More people seem to prefer repealing the law completely than simply excising the individual mandate. It may not be possible to eliminate the mandate alone, which could force the Supreme Court to consider striking down the law in its entirety.

Option three: Obamacare is struck down in its entirety
Since the law's progress became public knowledge in 2009, the vast majority of up-or-down polls conducted have shown that Americans oppose it and prefer repeal. Aggregate polling data from RealClearPolitics, which has tracked over a hundred polls on the subject, shows that about 50% prefer repeal, compared to about 39% in favor of the law. More detailed surveys offering multiple options are less clear, with just over a third of respondents generally favoring complete repeal.

Some possible winners from a complete repeal include high-earning property owners, who would face a capital gains tax on their real estate profits over a certain threshold if the law is upheld. Many health-care companies would also benefit from relaxed regulations. The American public, particularly higher-risk individuals, could lose a great deal of protections. They may not lose everything, though -- major insurers have pledged to continue some of Obamacare's more popular policies, such as coverage of children up to age 26 on a parent's plan, regardless of the judicial outcome.

Hospitals are also likely to get the short stick from repeal, since they would still be forced to treat individuals who might have otherwise purchased or been granted insurance.

Option four: The justices (or Congress) mandates multiple changes
If the individual mandate can't be removed on its own, large parts of Obamacare might need to be changed or struck down. The entire part of the law dealing with insurer behavior toward certain populations might be scrapped. That could leave a shell of reforms that does little other than expand the government's support of low-income individuals and its regulation of some "unhealthy" industries.

Congress may choose to continue some of Obamacare's popular policies regardless of the Supreme Court's decision. Expanded coverage for young people and the ban on discriminating against pre-existing conditions are both well-liked provisions. Republican leaders are open to retaining or reinstating these parts of the law even if it's struck down completely, so there are likely to be some lasting changes to American health care no matter the decision.

What do you think?
Obamacare is a highly complex law with many moving parts. It's nearly impossible to say -- not to mention foolish to predict -- which way the Supreme Court may rule. But no matter what happens, Obamacare has and will affect all Americans in some way or another, whether they're forced to buy health insurance or can simply give coverage to their children for longer periods of time. Can the government force you to buy something if it's considered a necessity? Which way should the court rule? Let me know what you think in the comments box below. I know you've got an opinion.

Fool contributor Alex Planes holds no financial position in any company mentioned here. Add him on Google+ or follow him on Twitter @TMFBiggles for more news and insights.

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Read/Post Comments (63) | Recommend This Article (36)

Comments from our Foolish Readers

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  • Report this Comment On June 21, 2012, at 10:48 AM, ericandmisti wrote:

    It is totally unconstitutional for the government to mandate that everyone buys insurance. This is not a $5 item. The cost for a normal family policy is more than $12,000 per year. Most of us don't see the full cost because our employer is paying the majority of it. How can the government tell Joe worker making $45K with a wife and two kids that he needs to spend more than 25% of his income to purchase a government mandated policy? The whole point of the mandate is to force healthy 22 year olds who never go to the doctor (and are very unlikely to need any treatment that will cost as much as the annual premium) to buy a policy that will never pay out any money to subsidize older and less healthy people. I personally did not have insurance in my 20s and never went to the doctor. It is easy to sit back and say everyone should have insurance, it is quite another to figure out who and how it will actually be paid for. The costs to individuals and government for Obamacare are staggering. Anyone who thinks you can insure tens of millions of people without it costing the government anything didn't get very far in school.

  • Report this Comment On June 21, 2012, at 11:06 AM, gearoil wrote:

    And they probably went to harvard too

  • Report this Comment On June 21, 2012, at 12:38 PM, CluckChicken wrote:

    On the other side ericandmisti why should somebody with insurance have to pay more because those with insurance end up covering those without?

    The fact that somebody that seeks medical treatment can not be denied and much of the time they can not afford it the costs just get passed onto those that can. Something needs to be done to change this. Either everybody gets coverage or treatment can be denied.

  • Report this Comment On June 21, 2012, at 12:42 PM, bignort2001 wrote:

    Hence the reason for the mandate. The bigger problem, and one seen in MA under Romneycare, is that people forgo insurance and pay the penalty (which is far too low) until they get sick, then stick the insurance company with their ill health. Then repeat the cycle.

    Add into that the fraud of illegals, and foreigners using health care that they are not supposed to be able to get (another problem from MA, where people have come from neighboring states to get healthcare when they get sick, but there aren't effective barriers in place) and you have a law that will massively raise the cost of healthcare without the inevitable rationing of care seen in all other states that have universal coverage.

  • Report this Comment On June 21, 2012, at 1:41 PM, DoctorLewis4 wrote:

    It is totally unconstitutional for the government to mandate that everyone buys auto insurance. This is not a $5 item. The cost for a normal family policy is more than $1,000 per year. The whole point of the mandate is to force good drivers to buy a policy that will never pay out any money to subsidize bad drivers. Of course this is all Obama's evil auto insurance plan hatched before he was a born in Nigeria.

  • Report this Comment On June 21, 2012, at 1:52 PM, mdk0611 wrote:

    Should 22 year olds in Manhattan who use mass transit and don't own a car be forced to purchase auto insurance?

  • Report this Comment On June 21, 2012, at 2:02 PM, CluckChicken wrote:

    "Should 22 year olds in Manhattan who use mass transit and don't own a car be forced to purchase auto insurance?"

    If you dont have a car how could you possible end up in a situation in that you would need auto insurance? To compare health insurance to auto insurance is pretty silly.

  • Report this Comment On June 21, 2012, at 2:13 PM, DoctorLewis4 wrote:

    Satire. See first post. Of course you can't compare the two. But if it's not unconstitutional to mandate auto insurance how is it suddenly unconstitutional to mandate health insurance? Remember, the heath insurance mandate concept came years ago from Republican Senator Bob Dole, who thought it was unfair for hard working people who paid for their own heath insurance to subsidize those who went uninsured and stuck the tax payer with the bill.

  • Report this Comment On June 21, 2012, at 2:34 PM, TMFBiggles wrote:

    I would like to point out that I in no way condone referring to Snooki as a "celebrity." I greatly regret this error.

    - Alex

  • Report this Comment On June 21, 2012, at 2:35 PM, TMFMorgan wrote:

    <<I personally did not have insurance in my 20s and never went to the doctor.>>

    Many, many others don't have insurance and do end up going to the doctor.

    <<Anyone who thinks you can insure tens of millions of people without it costing the government anything didn't get very far in school.>>

    Who has made that argument?

  • Report this Comment On June 21, 2012, at 2:39 PM, CluckChicken wrote:

    "Remember, the heath insurance mandate concept came years ago from Republican Senator Bob Dole"

    Actually it came from John Adams with the 'Relief of Sick and Disabled Seaman' act that was passed by Congress on July 16 1798. John Admas wouldn't know anything about what the Founding Fathers meant when writing the Constitution.

  • Report this Comment On June 21, 2012, at 2:41 PM, TMFMorgan wrote:

    Here's a good article on how feelings toward the mandate have changed over the years:

    http://www.newyorker.com/reporting/2012/06/25/120625fa_fact_...

  • Report this Comment On June 21, 2012, at 2:54 PM, jtmccjr wrote:

    I do not pretend to know each and every nuance about the Affordable Care Act, nor am I an expert in constitutional law, however, I support the Act in it's entirety. I would have preferred a single payer system but it appears that would never fly in our highly partisan political environment and might even start a civil war. I strongly feel that health care should not be treated as just another business sector and should not be a profit center the way other business sectors are. The health of our citizens is too important to allow a free market approach. I understand that there are problems with single payer systems and the Affordable Care Act has and will have problems. But it is a good first step in reducing health care costs over the long term and, more importantly, ensuring that every citizen has access to affordable health care. The nation and American companies will benefit from a healthier, more productive citizenry.

  • Report this Comment On June 21, 2012, at 3:36 PM, jgutshall wrote:

    Perhaps we should treat health insurance the way we treat life insurance. If you defer coverage, the price increases. Insurance is a risk pool. If you are not in the pool, pay as you go --- pay at the door before treatment. If you assume the risk, you pay the price.

    Obviously, the above scenario would not work. That is the reason for the mandate.

  • Report this Comment On June 21, 2012, at 4:44 PM, sheldonross wrote:

    DoctorLewis, the fallacy in your argument is that the Federal government DOES NOT mandate auto insurance. That's a STATE issue. New Hampshire does not require auto insurance.

  • Report this Comment On June 21, 2012, at 4:55 PM, bignort2001 wrote:

    Not only is auto insurance a state issue, you are required to buy it for your LIABILITY if you hit someone/something. Not applicable to someone who doesn't have a need for insurance due to youth or good health.

    The idea that you will need it someday so we can force you to carry it for years and years before you may actually need it, is really laughable.

  • Report this Comment On June 21, 2012, at 5:42 PM, Truth2Power wrote:

    @DoctorLewis4: Why not:

    It is totally unconstitutional for the government to mandate that everyone buys social security. This is not a $5 item. The cost for a normal family is more than $1,900 per year. The whole point of the mandate is to force young people to buy a product that will never pay out any money to young people to subsidize old people. Of course this is all Obama's evil Social Security plan hatched with socialist bipartisan support before he was a born in Dog-eating Land.

    Hey, I ain't crazy about forcing folks to buy insurance. I'd rather see a public option. But everyone's going to need some sort of healthcare eventually, even if it's just emergency services showing up to determine that you don't have a pulse (that ambulance ride your corpse takes? That's a healthcare expense in many if not most jurisdictions).

  • Report this Comment On June 21, 2012, at 5:45 PM, Truth2Power wrote:

    @bignort:

    But what if a healthy (apparently), young person suddenly develops cancer, or has a previously-unknown heart defect? Why should everyone else then have to pay for the hundreds of thousands of dollars in treatment that individual will then require? Nobody knows when they'll need it: just like nobody knows when they'll have a car accident.

  • Report this Comment On June 21, 2012, at 6:11 PM, gtbohrer wrote:

    For the folks (I started using another term, but it wasn't particularly respectful) who are comparing auto insurance to health insurance...

    Auto insurance isn't mandated for everyone.

    It is required to operate a vehicle on public roads (in most places). The state governments regulate the public roads...last I checked, the act of breathing wasn't regulated by any public entity.

    Big difference.

    The key to satire is a kernel of truth...some folks just ought not to be trying this at home.

  • Report this Comment On June 21, 2012, at 6:41 PM, Truth2Power wrote:

    @gtbohrer:

    You're right: the parallel isn't exact, but the aspect of the insured (whether drivers or healthcare users) paying the costs incurred by the uninsured (drivers who have an accident or individuals who have healthcare costs) is a parallel situation.

    Breathing, however (or at least WHAT you are breathing) actually IS regulated: by the EPA under the mandate of the Clean Air Act.

  • Report this Comment On June 21, 2012, at 7:26 PM, DoctorLewis4 wrote:

    Here's some comedy - parsing the term mandate! Paging Bill Clinton! Where I live I can't legally operate a motor vehicle without proof of insurance. By any reasonable definition I am mandated by my state to have insurance or I can't drive. For purposes of this discussion I'm not talking about driving a lawn mower down to the fishing hole.

  • Report this Comment On June 21, 2012, at 8:23 PM, 2sour wrote:

    Interesting discussion, but why isn't there more discussion about ALL the mandates that we submit to and pay for:

    - why am I forced to pay the government to illegally spy on me

    - why am I forced to pay the government to illegally search me?

    - why am I forced to pay the government to conduct illegal wars?

    - why am I forced to subsidize farms, timber, mining, oil, big defense corporations, etc?

    - why is it mandated that I must educate my child?

    - why am I forced to pay for roads, bridges, and all kinds of pork projects that I'll neverknow about or see?

    - why am I forced to pay to protect the entire world from "evil"?

    - why I forced to pay into a social security system that is more than compensating an entire generation who simultaneously believes that they "paid their share" and that the whole thing is "ponzi scheme"?

  • Report this Comment On June 21, 2012, at 8:37 PM, hbofbyu wrote:

    When I was unemployed I bought catastrophic insurance and paid cash straight to the doctors at half price for everything else I needed. It wasn't that expensive going that route. I know there are corner cases where I would have been screwed if I needed an expensive drug etc. But you can really cut your costs if you can eliminate the insurance companies, the billing companies, the drug companies and of course the lawyers.

    All I know is that new and complex laws and regulations never have unintended consequences, no inefficiencies, and no budget shortfalls. This will be a thing of beauty . (sarcasm for everyone)

  • Report this Comment On June 21, 2012, at 11:02 PM, skypilot2005 wrote:

    From the White House:

    http://www.whitehouse.gov/health-care-meeting/questions/no-i...

    “Q: Can I afford coverage?

    A: Clearly, the system we have today is broken. If you don’t have health coverage, there’s no limit on how much insurance companies can charge you, and they can decide to refuse to sell you a policy at their whim. Health insurance reform will change all of that.

    • For the first time in history, there will be limits on how much anyone will have to pay to receive health care coverage. And depending upon your income, you may be among the tens of millions of Americans who will get a tax credit to to help pay for your coverage.”

    There are still going to be some folks subsidizing others via premiums or taxes under Obama Care.

    That’s why it will do nothing to contain costs.

    What is the difference between an uninsured person showing up at a hospital now or a person with a tax credit under Obama Care?

    None. Someone else is going to pay the cost of treatment.

    Sky

  • Report this Comment On June 22, 2012, at 7:30 AM, etbean wrote:

    Access to medical treatment is a human right or should be, not to depend on one's earning ability or assets!!!!!!!!!!

  • Report this Comment On June 22, 2012, at 8:52 AM, StopPrintinMoney wrote:

    option one is not an option.

  • Report this Comment On June 22, 2012, at 9:45 AM, TXRob wrote:

    I vote SPP option.

  • Report this Comment On June 22, 2012, at 11:10 AM, ericandmisti wrote:

    @TMFMorgan,

    For the record, it was Obama who said this program was not going to cost anything and would save money. The problem was the program didn't include anything to control costs. Just mandating that insurance be more generous in coverage and everyone must buy it does not decrease costs. I am old enough to remember when they first mandated buying auto insurance in my state. The price of insurance did not go down as promised (not having to pay for uninsured drivers was supposed to save insurance companies a lot of money and reduce rates), it went up.

    I also agreed with Sky's comment that one way or another we are still paying for the insurance since the government is going to subsidize insurance for a huge percentage of the people (the plan calls for subsidizing insurance on a sliding scale for people making up to 400% of poverty which for a family of 5 would be over $100K, in other words almost everyone would qualify). I think Obamacare will cost me far more both in the cost of insurance and taxes than the cost of a few people who go to the hospital without insurance.

    I don't think many of the people who support the government controlled health care have any experience with it. No program the government has gotten involved in has ever become more efficient and less expensive (try to think of something the government does efficiently). The government does a terrible job at running anything and cannot even begin to compete with a private company on controlling costs. I have worked overseas and know people who live in multiple countries with government provided healthcare. Some of them have private insurance so they don't have to use the government system (that is right, people who have the ability spend extra money to get better care). The quality of care is not nearly as good as ours and there definately is rationing. You can easily wait a year for a treatment that you could walk into a hospital and get right away in America. Also in case no one has noticed, Europe which is the poster child for the single payer system is on the verge of financial collapse from overspending.

    Eric

  • Report this Comment On June 22, 2012, at 11:54 AM, GWBram wrote:

    In my way of thinking the individual mandate is scarcely the worst part of ObamaCare. The law

    will be a weight on our economy that will drive up

    our unemployment numbers enormously as businesses will be much less kikely to hire new employees, if they can keep in business at all, with the cost of the $2000.00 penalty for a non compliant plan. Compliant plans will likely cost far more than the cost of incurring the penalty but it

    is still too much for many businesses to bear. It scares me that this law may be left to stand even if the individual mandate is deemed unconstitutional. ObamaCare was written so that, if any part of it was deemed unconstitutional, then the whole law must be thrown out. What happened to change that?

  • Report this Comment On June 22, 2012, at 12:17 PM, gene31528 wrote:

    Many seem to forget that social security and medicare were passed via the comerce clause.You had no choice SS and medicare tax was deducted from you pay. The individual mandate was written via the comerce clause that gives congress to write certan laws

  • Report this Comment On June 22, 2012, at 12:43 PM, leslie1041 wrote:

    First let me say that I oppose government delivery or reimbursement in health care delivery and pricing and I currently am not involved in either. Although I have worked for the AMA and owned my own health claims reimbursement business. Government has done more to increase the cost of health care than all the other parties put together. The incentives are for providers to chase higher fee profiles and hospital to seek higher reimburse.

    The abuses in Medicare and Medicaid services are horrendous and should not be expanded until something is done to reduce what services are rendered and what is a reasonable payment to be paid. There has to be a relationship between benefit of service and payment with the patient and physician having equal risk that if it is not necessary both can be required to suffer the financial loss. Yes that includes Medicare and Medicaid. Many of these patients and many in the private sector are determining the services the physician will render by complaining of self diagnosis and symptoms that currently require the physician to render a battery of test to rule out that there is really nothing wrong other than the patient has a minor ache or pain.

    We need to go back to there being a cost to the patient for all services rendered and not just the premium that they paid which they think gives the right to seek care rather than to need care. This industry is not base on supply and demand. It is more based on what can the providers charge. The paperwork for providers has to be reduced and not just through computerization. The privacy act needs to be eliminated and replaced with something that has some “teeth”. If I go to the drug store to pick up a prescription I have to stand in line to sign all the privacy forms. Try going to a medical facility and it takes 30-45 just to complete the forms. You better hope it is not a life death situation. Now people call 911so that they can be submitted through the emergency room faster. The system is broken and needs to be fixed with the help of government not by government.

  • Report this Comment On June 22, 2012, at 12:58 PM, thesalesman87 wrote:

    when the congress and all federal employes have the same health care as they want me to have maybe I might listen, but they sure made sure that they did not. so the whole plan need's to be struck down and start over with the public input this time not behind closed doors, like the lady speaker wanted the deal done the last time. the SALESMAN

  • Report this Comment On June 22, 2012, at 12:59 PM, grok66 wrote:

    Ericandmisti, et.al. My families experience with Medicare has been first rate. My wife recently went on Medicare and we have been pleasantly surprised. One of the first questions you and like minded people have to ask, is what the author asks. Do you think health care is a right or a privilege? If you think it is a privilege, nothing I or anyone else can say will change your mind. All I can say is that I did not regret one single dime I have paid into social security, Medicare or Medicaid...and for that matter nor taxes for 50 years. I have regretted what my government has done with some of my taxes, military industrial complex for example, but we seem to be heading in a better direction there. At least we are attempting to cut back, unless politics as usual takes over. So, the hard questions are what are we going to do about keeping our country healthy? I simply don't understand why we can't have a single payer option, and if rich people want to buy additional coverage let them do so. Medicare for all would work..if we have the will to make it work. What it gets down to are priorities. I would like to have a healthy public. The question is really about how much are we willing to pay, and do we get our 'greed' for profit under control, isn't it?

  • Report this Comment On June 22, 2012, at 1:13 PM, BlancheDuB wrote:

    It is NOT unconstitutional to mandate healthcare from individuals. If it were, it would also be unconstitutional to mandate school attendence, driver's licenses, and car insurance.

    ALSO: Not mandating individuals without insurance to get it puts the burden on the tax-payer. How is that smart?

    ALSO: What kind of nation do we want to be. The backward kind that doesn't care about the health of our society? If so, get me out of here. I'd rather live in Germany or Denmark or any place in Europe where societies are smart enough to know a healthy public is essential for a healthy country and prosperity.

  • Report this Comment On June 22, 2012, at 1:18 PM, marshgator wrote:

    Created in a back room by a select few zealots who want to control our lives isn't my idea of compassionate legislation. It is what it is...let's do this right with more input by the governed.

  • Report this Comment On June 22, 2012, at 1:31 PM, VeeSan wrote:

    I find it interesting as a person in the medical field that people don't believe they are ever going to experience a catastrophic health issue. It seems to be some delusion that young people don't get sick or experience accidents. But when it does happen, there is no limitation to what is expected to be done to preserve that life because they are young with a full life yet to be had and it becomes quite emotional and personal. Someone pays for that. When my daughter fell off my insurance at age 22 and was still in college, I jokingly told her not to go anywhere until I secured coverage for her. She has had to go to an emergency room twice in her young life for appropriate reasons and the bill has never been less than $5000. Frankly, seeing what I do, I would be scared not to have insurance.

  • Report this Comment On June 22, 2012, at 1:45 PM, ejprzybylski wrote:

    It is not in the government's interests within the bounds of the Constitution to look after the individual health of the Nation's citizens. If the government wishes to reduce the cost burdened on those paying taxes resulting from health care for the uninsured, then it needs to takes steps to alleviate that cost without creating an unconstitutional mandate or more government bureaucracy. Several possibilities:

    1. Remove the restriction that health insurance policies cannot be bought across state lines. This will increase competition and cause insurers to compete on price and performance for the dollars of many.

    2. Subsidize health insurance costs for lower income brackets using a reimbursable tax credit. Scale this credit down as incomes rise. This maintains free market principles and continues the trend that the best plan/care will be sought by individuals based on their own needs.

    3. Serisouly crack down on Medicare and Medicaid fraud. Tie reimbursement to recoveries.

    4. Allow every citizen, working or not, to establish a tax deductible health savings account, with certain limitations on contributions, of course.

    These simple steps will greatly increase the accessibility of affordable insurance. But, in the end, personal responsibility prevails. At some point, you cannot force anyone to take care of themself, and it is each individuals own acceptability of risk which will determine whether they get insurance or not.

    My personal opinion is that this is another step in the direction of socialized, nanny-state government. This is a measure that makes us perform an action, and I resent my government for dictating that. But this is just one Libertarian's opinion.

    ejp

  • Report this Comment On June 22, 2012, at 1:58 PM, ejprzybylski wrote:

    BlancheDuB,

    The differences between a federal mandate of health insurance and myriad state mandates for various forms of auto insurance (or driver's licenses) are many. Most notably, citizens have a choice to drive or not. The ability to drive a vehicle is not a human right "ordained by our creator." If one wishes to choose to drive, then they are obliged to drive competently, lest they could easily kill or hurt somebody--thereby inpinging on the victim's right to live. They also are obliged to have some auto insurance, to cover or defray the costs of victims of their mistakes or recklessness. I can choose to not drive if I don't want to pay for auto insurance or get a driver's license; I may not like that choice, but it's still a choice.

    The MAJOR difference about the individual mandate is that it removes all choice. By virtue of simply living (something I must do, obviously), I have to buy a product or commit a crime (punishable by fine, or jail, should I refuse to pay the fine). I believe it is fundamentally wrong, and is a violation of my human rights, for a government to force me to either pay or be incarcerated simply as a result of me choosing to live. That sounds dramatic, but at its basic elements that's what the choice is.

    I can't even draw a correlation to income taxes in this case. I must pay income taxes or go to jail, but even then, I still choose to work. Once again, not an easy choice, but a choice nonetheless. That is why this mandate is unlike anything else, all choice is removed.

  • Report this Comment On June 22, 2012, at 2:47 PM, Lulufrench wrote:

    Of course one of the major differences between auto insurance and health insurance is that car insurance only covers repairs to cars that were in accidents or medical care to people affected by the car. It does not cover routine maintenance, or even major system breakdown (e.g. transmission, A/C). Realistically, present-day car insurance should be compared to a policy that only covers catastrophic health care, not routine. If car insurance had to cover oil changes, tire rotation, battery recharges, etc. the premiums would also be unaffordable for many. (is that a word? :)

  • Report this Comment On June 22, 2012, at 2:51 PM, Lulufrench wrote:

    @ejprzybylski Yes, yes, and yes again about insurance companies being able to sell nationwide instead of licensing them state by state! The lack of competition in some smaller states effectively creates monopolies for the few companies that remain.

  • Report this Comment On June 22, 2012, at 3:50 PM, gamblegold wrote:

    Morgan - thanks for the article and the stimulating debate which ensued. it is clear from the opines here that the difficulty in crafting some appropriate healthcare reform entails displeasing some of the people all of the time and all of the people some of the time.

    As a person who is a successfully self-taught investor and who has spent the majority of the last 46 years significantly to severely disabled, i have some of my own thoughts.

    First, in regard to the 'broad strokes' you outlined above, to wit:

    "Expanded health-care coverage, particularly for higher-risk populations."

    yes, please. it is the single most fearsome factor as we all-too-rapidly approach retirement and face the need to apportion our retirement to include 'self-insurance' wherein we have some very small limited control on spending but none whatsoever upon the costs and, more importantly, the profits demanded by the system.

    "Tighter and more regulations of the medical insurance and health-care industries."

    as stated, to imprecise to be meaningful and i am old enough to markedly distrust political promises without seeing the 'devil-in-the-details'. realistically, since corporate america owns our political system, it seems highly unlikely that any meaningful regulation of the industries will result. more likely is the limitation of services where regulation sufficiently interferes with corporate profits to make service delivery untenable. there won't be much tears shed over what this means to the patient, i can assure you.

    "Expanded Medicaid coverage for the poor."

    Certainly. But who pays for it and is that cost burden being placed in the appropriate place(s)?

    "Improved health-care efficiency and quality via an oversight board."

    hahahahahahahahahahahahaha.... this is, to me, political pandering. medicine should not be practiced by formulary and one-size does NOT fit all (an already too-present result of the supposed benefits of HMO's touted several decades ago but which never came to pass). The only government oversight tact ever demonstrated (certainly in the areas of finance, food quality and social services) is the blind one-size-fits-all mentality coupled with the penchant for spending 90% of the dollars to fix a 10% problem -- most notably where the governments spend extraordinary sums out of all proportion to the fraud/waste they are supposed to be avoiding.

    In short, i've already spent the last 30 years battling the corporations to get the proper medical treatments. i've spent countless hours on the phone and corresponding with bean-counting idiots (with apologies to real idiots for the association) who haven't a shred of medical knowledge but are going to argue and deny coverage for procedures my doctors say are vital. no, thanks, i don't want their 'oversight'.

    "Health insurance exchanges/marketplaces that will help individuals and small businesses better manage their insurance costs."

    I haven't the vaguest notion of what this really means, if it means anything at all. i suspect it doesn't but it sure sounds good, don't it? are they proposing some sort of grey-market barter system of health points or insurance coverages being swapped? ???

    "Mandated health insurance for employees at companies with more than 49 employees, with a tax penalty for companies that don't comply."

    i have watched for the last five years as my son and my wife have lost more and more 'benefits' from their employers. for example, we're supposed to have regulations against forcing employees to work overtime without pay (when hourly, as my son is) but my son routinely is forced to work 10-11 hour days at standard wages (all benefits were terminated by the company in 2008). then, when they run out of work, they get laid-off for anywhere for two weeks to a month. just short of being eligible for unemployment. then they get called back to the meat-grinder.

    they are, by no means, alone. yet - having 'government oversight' in this area turns out to mean nothing at all. so how am i to believe that mandating insurance isn't more cow-pie-in-the-sky political promises that either don't actually improve anything or, worse, make things a whole lot worse?

    moreover, the government mandating another tax (and that's the only way governments get income) is by no means an assurance that self-same government will actually SPEND that money on things that lower the insurance rates for the rest of us.

    "Greater government effort to control chronic health problems such as obesity."

    ABSOLUTELY NOT. as a former obese person, i KNOW the issues involving obesity are complex and require highly trained medical experts (and this rules out alot of doctors, btw) working with patients. i do not want and i will not trust any government agency or employee to think they can practice medicine on me simply because they see me as 'fat'.

    this is the same government that continues to encourage and profit from the distribution of harmful substances to adult populations (tobacco; alcohol) and refuses to examine the medical benefits of things like cannabis unless some giant pharmaceutical company can corner the market. if the government profits from unhealthy practices, where exactly to they come off tell me how to control 'chronic' health problems?

    besides, and most importantly, chronic health conditions are most often symptoms of other, more serious and frequently undiagnosed underlying conditions. why not have a government agent out on every corner with a box of band-aids to put something on every boo-boo that comes along -- its just about as meaningful a concept.

    "An "individual mandate" that requires most uninsured individuals without extenuating circumstances to purchase insurance or face a tax penalty."

    lacking in details as this does, it appears to be unenforceable -- and, as i understand it, any provision made law which is deemed unenforceable is de facto unconstitutional.

    ****

    there are, in short, three things that trouble me about this attempt at healthcare reform: 1) it does little to reign in the corporate greed side of the equation, 2) it depends too much upon federal government 'oversight' into individual lives which seems utterly impractical and 3) it seems to remove or limit the individual sense of responsibility as a major part of the equation. it's as if we're all so childish that we cannot take care of ourselves.

    anyway, moo, fwiw, ymmv and hand.

  • Report this Comment On June 22, 2012, at 4:23 PM, copywrites wrote:

    On the Individual mandate, several thoughts, but the prmary one is that a logical argument suggests you must either mandate every citizens' participation in insurance, OR, you must allow a doctor, hospital, etc. to deny services to uninsured people. Both cannot exist together unless those paying for insurance are willing to subsidize the cost of those not paying for insurance. Personally I believe that if a person makes a decision not to own insurance, then he/she is willing to accept death as a risk of that decision. I believe people today don;t buy insurance because they know they will not be denied services if they do become sick or have an accident.

    Beyond that, I deplore the argument about the cost of insurance. Yes, if you want to have every nickel and dime of your health care to be covered by insuance, it WILL be expensive. But it can be quite reasonable if you choose to have high deductables or choose to have coverage only for hospital care. Years ago I had to provide coverage for myself for about 6 months until my new employer insurance kicked in. I bought a policy that had a $10K deductable and only paid when I went to the hospital - no coverage for regular Dr. visits. The cost of that coverage was very affordable and I was not making much money at the time. To the best of my knowledge, the law does not specify the type of coverage of insurance - only that you must have it. Once this law goes into effect completely with the individual mandate in place, I predict a wave of low-coverage, low cost policies will become available instantly - similar to what we already see in the car insurance industry. Coverage only for the absolute minimum required by law.

  • Report this Comment On June 22, 2012, at 5:01 PM, MojaveAVSHS wrote:

    Re: "Actually it came from John Adams with the 'Relief of Sick and Disabled Seaman' act that was passed by Congress on July 16 1798. John Admas wouldn't know anything about what the Founding Fathers meant when writing the Constitution."

    from Cluck Chicken.

    This was international commerce, NOT interstate commerce.

  • Report this Comment On June 22, 2012, at 8:01 PM, RushBabe49 wrote:

    If ObamaCare is upheld, Kathleen Sebelius will run your life. MANY details in the law say...as the Secretary shall direct. Do you want one un-elected bureaucrat in DC essentially running your life? Nobody comes between my doctor and me, and I'm willing to pay myself for anything denied by insurance (My MD has a membership practice, and I pay her $100 per month to be her patient). Personally, I will go to jail gladly before I obey that law. And, just in case anyone does not know the difference between a "right" versus a "Privilege", anything that costs someone else to provide to you cannot be a "human right". Health Care, Housing, Food, are NOT RIGHTS. They must be earned.

  • Report this Comment On June 22, 2012, at 9:43 PM, larrrup wrote:

    The government has no business in health care. They could screw up a one car funeral. It will bankrupt our country if the free spending doesn't allready. It is definately unconstitutional, something that his royal highness Obummer knows since he was a constiutional lawyer. He doesn.t care he wants to rewrite the constitution to suit his view of the United States, If re-elected he will get an opportunity to add more people to the Supreme court that make decisions based on what they think and feel rather than the constitution.

  • Report this Comment On June 23, 2012, at 4:51 AM, mdriver78 wrote:

    The unemployment currently weighing down this economy is almost certainly tied to the uncertainty that this healthcare program has placed on potential employers. Said another way, Companies are not hiring because the potential burden of the healthcare cost is too much. This is highest percentage on unemployment in my lifetime and the only real differentiating factor is Obamacare!

  • Report this Comment On June 23, 2012, at 9:51 AM, msw48 wrote:

    It seems to me that medical insurance is the biggest problem in our medical care system today. The extra layers of bureaucracy, from billing clerks up to insurance company CEOs, inflates the cost of everything. With medical insurance, also consider:

    > The final decision on an expensive treatment regimen may be made by a high school graduate running an algorithm on a work station.

    > It seems that insurance companies are primarily concerned with collecting premiums and secondarily concerned with finding a way to deny claims. Why would we want this vested interest complicating our medical care decisions?

    > Why should our medical care have anything to do with our jobs. Must we stay trapped in a bad work situation to protect our coverage. Better to eliminate the linkage, altogether, rather that try to legislate a fix to this senseless situation.

    > So, what is wrong with going to a doctor or clinic or hospital and getting billed for the service. All services would be less costly without the insurance bureaucracy. Just have insurance for catastrophic costs at a reasonable cost. If one chooses no insurance and refuses to pay for services rendered, let their credit rating reflect this.

    After years of having employer provided medical insurance, I became self employed in 2000. I went to open a medical savings account, but all that I could find was HMO style options. There were no options for the low cost, high deductible, catastrophic coverage that I desired.

    The point is that all of our options seem to be focused on what is best for the insurance companies, not for the patients.

  • Report this Comment On June 23, 2012, at 11:14 AM, satinstitch wrote:

    Health insurance is neither a right or a privledge, it's a personal choice. Individuals who are continually given products and services when they don't have a personal investment in those items tend to abuse them. Most people are willing to help those who' ve had an unexpected blow set them back but so much of what would be mandated health care money would be going to those who didn't care enough about themselves to do the little preventative things to keep themselves healthy in the first place.

    Those who have to work for living already have to pay for politicians healthcare and their retirement plans. Instead of forcing those same individuals to also pay for those without ask the politicians to give up just those two plans to cover the cost of healthcare for those without.

    The more you give away for free the longer the line gets.

  • Report this Comment On June 24, 2012, at 9:52 AM, crna80 wrote:

    A lot of interesting perspectives. Let's see who already has a single payer system- folks on Medicare, Medicaid, the VA, government employees.

    so this bill is for the rest of us. If you participate in those programs, then I think you should have no say about the benefits for the rest of us. My husband is from Canada and i have seen first hand the reduced stress from medical worries there. also, the gov't has an incentive to encourage healthy living, so there is more backlash against unhealthy food additives, and encouragement for exercise.

    I worked in an operating room for 30 years. doctors used to say no insurance, no pay. Imagine getting called in the middle of a snowy night having to get out of your warm bed, to drive to the hospital to deal with a car accident of someone who has no insurance. Great! You don't get paid, plus they can sue you if you screw up. Wow, I want that job. (sarcastic, in case it is not clear. ) Obamacare is not the answer, but it is a step and it starts the conversation, which is badly needed, Until all the players are out of the system financially, it will not be a good system. Health is not a commodity that you decide whether you want it or not. Therefore it should not be a market driven business. It doesn't work.

  • Report this Comment On June 24, 2012, at 11:22 AM, blokhead wrote:

    What ever happened to responsibility? Shouldn't we be responsible about trying to be healthy? Should we go to MD simply because the co-pay is $10-$25, when we have minor ache or pain? It's because co-pays are so low that people go to doctor needlessly. This is what is driving medical costs through the roof. No real need to see the doctor, but insurance has to make payout.

    Yes, I understand there are people who through no fault of their own, are in dire need of medical attention - Those are the people who deserve our help.

  • Report this Comment On June 24, 2012, at 8:38 PM, tillim wrote:

    the price of a pack of cigarettes in canada is $13. why are we 8 bucks behind? that would go a long way to subsidizing healthcare. alcohol is also more expensive there.

    stats on trauma centers in the US. mostly young otherwise healthy people, uninsured. events involving alcohol.

    taxpayer pays.

  • Report this Comment On June 24, 2012, at 10:07 PM, angela0031 wrote:

    "The nation and American companies will benefit from a healthier, more productive citizenry."

    I agree with this completely, but giving (or forcing) healthcare insurance does not guarantee health or a healthier citizenry.

    Only the people themselves can choose to make themselves healthy - by exercising, eating real food and consuming reasonable portions of food and other substances.

    I do NOT want to pay for somebody else's disease and most diseases are self-inflicted. It's not fair, it's not right, and it's un-American.

    Something needs to be done so that hospitals can turn away those who do not have insurance or that refuse to pay on the spot.

    If the governments wants to get involved (besides passing a law that allows hospitals to turn people away!) then they should remove the grain subsidies, add additional taxes to processed food products, and require medicaid patients to pay a COPAY for goodness sake!

    Maybe if people had to pay for their OWN mistakes, they wouldn't make so many.

    Well, we all know that doesn't exactly turn out right. But those of us that are healthy and do pay for our own insurance, shouldn't be stuck footing the bill for everyone else.

    It's all related to the tax system we currently have - and that's why nobody should vote for Obama this November!

  • Report this Comment On June 25, 2012, at 4:53 PM, sbholdem wrote:

    I am all for Obama care if our governement workers and politicians have to use the "same Obamacare as I do. If EVERYONE gets FREE healthcare I'm for it. If not all you are doing is expanding medicaid. The rest of us forced to by our health insurance will go broke; along with the nation. If you think our national debt is big now, just WAIT until Obamacare hits us. BAD BAD BAD IDEA

  • Report this Comment On June 25, 2012, at 5:39 PM, DrWiseman wrote:

    The only legitimate function of government is to protect its citizens from enemies foreign and domestic. Everything else they get involved in sooner or later becomes an albatross around the necks of the citizens. A minimum benefit policy for every citizen should be mandated and all insurance companies be able to offer that policy to every citizen across every state line. Government subsidies to help with the premiums would be dependent on the income of the individual, i.e., a sliding scale. If one wants more coverage the he/she should pay for it. I put this plan together when Clinton was president. Since that date I've submitted to every elected federal politician. To say the least the response was under-whelming. The mechanics of the plan were so simple the Dr would have been paid before the patient left the office. Rest assured the Dr. part of my user name is legitimate.

  • Report this Comment On June 25, 2012, at 8:18 PM, JohnCLeven wrote:

    ["Whether or not the Supremes overturn the individual mandate, rationing is here to stay. You just won't here any politician use that term. Anyone schooled in health care economics understands this and realizes that it is the only way for this country to save itself from a populace who wants "everything done" until their last dying breath. As a medical professional with over 35 years of experience taking care of very sick people, I have come to understand and to compassionately explain to my patients, that there is no "everything"]

    This was the best comment i've read on the subject in a while.

    Technology has given us incredible ways to keep people alive, who 20 or 50 years ago would not have made it. Then problem is these procedures often cost hundreds of thousands of dollars. What is going to bankrupt us all is 80-90 year olds, who have lived a long and wonderful life, and now have an illness they cannot afford to treat which will cost the taxpayers 100k per year to keep them alive. That's 100k that could have gone to a house, an education, or an investment. One one hand, you can't blame a person for wanting to survive, that's basic instinct, nevertheless, the baby boomers medical cost are going to crush my generation (18-25) like myself who are already deep in student loan debt and will now have to foot the bill for medicare/medicaid as well.

  • Report this Comment On June 26, 2012, at 1:55 AM, VanArnold wrote:

    I think it very unwise to give the federal government the authority to force individuals to purchase items or services from private companies. It has never been done before and for good reason. I don't want the federal government telling me what I must buy from some greedy corporation. What else will they make me buy if granted that authority?

    Social Security and car Insurance are not the same. Social Security is a government service funded by taxes, so it is not a private enterprise. Car insurance is only mandated by state governments if you operate a car on public roads and don't have enough assets to cover potential damages you may cause to others, not yourself.

    If the government wants everyone to have health care, it should do what it does with every other service it wants to give people, levy a tax and then provide it or contract it out.

    I believe that health care is something that everyone should have regardless of income or health condition. The government should levy taxes and provide it, like clean water, sewer, fire, police, roads, military, education, and postal service.

    Another important fact to remember is that Health Insurance doesn't mean you have health care or good health, it means you just pay money to a profit motivated company that frequently denies claims in order to get those profits.

    .

  • Report this Comment On June 26, 2012, at 1:31 PM, sobe02 wrote:

    "if it's not unconstitutional to mandate auto insurance how is it suddenly unconstitutional to mandate health insurance?

    Apples and Oranges. Auto insurance is a consequence of buying a car. If health insurance is a consequence of living then the government could mandate we buy anything it wants.

    "why should somebody with insurance have to pay more because those with insurance end up covering those without?

    Actually, they don't by themselves. We all pay because hospitals can't deny treatment...so the costs come from private and government insurance plans. More important, if the folks treated "for free' can't pay then they can't pay insurance premiums...so again, we will all pay regardless of a mandate.

    Frankly, if Obama had the guts to deliver on real change when he had a democrat controlled congress, he would have supported putting everyone on Medicare from birth...paying for it by means testing premiums and a tax on foreign oil.

  • Report this Comment On June 27, 2012, at 11:31 AM, emptorski wrote:

    "Should 22 year olds in Manhattan who use mass transit and don't own a car be forced to purchase auto insurance?"

    No, they should not. Not unless they own and operate motor vehicles on public roads.

    All those who operate motor vehicles in public streets should purchase auto insurance.

    All those who operate bodies in public places should buy health insurance.

  • Report this Comment On June 27, 2012, at 3:04 PM, bcrich33 wrote:

    I love the left..."well its not unconstitutional to mandate auto insurance" - omg....is there a mandate to drive?? ummm...no....walk...ride a bike...use public transportation.....Obama wants to charge you to be....I don't want a Nanny state...and never does the vast majority of voters....wait and see Dr Dopey

  • Report this Comment On June 28, 2012, at 11:17 PM, Gabbitha wrote:

    In current deteriorated state of the healthcare system in the country, the government ends up footing the bill someway, somehow - be it through Medicaid, Medicare, subsidizing local hospitals and clinics, etc. I think this new law looks to merely shift the government monies currently being used from one "category" to another. This also shifts some of the costs to the general population. The pro here is that everyone will "pool" their money together to get everyone covered. This will hopefully reduce the amount of money the government has to spend (and gets from our taxes) on things like an emergency surgery to clean someone up after his or her appendix has erupted. Rather than going to the doctor immediately when the pain strikes, this person will hope the pain goes away and consequently makes the problem worst.

    As far as I understand there is also an exception that can be filed to exclude one from the "individual mandate" portion of the law under the grounds of religious objections or financial hardship. The ones I see will be hard hit are small businesses. I don't know how that's going to fare. Also, businesses are already taking their businesses outside the country for cheap labor, how will this further affect this situation?

    Last thing I will say is that Obamacare won't fix our broken system. The reason why health care is SO expensive is because there are many inefficiencies, among many other things, in the system. Another issue is greed...well, a businesses purpose is to be profitable so they essentially have a right, in our capitalist society to charge as much money as they want. Basic supply and demand. The system, as I see it, can only be fixed if the government completely absorbs the health care system, controlling all aspects of it rather than buying the services from various companies. But we all know how wonderful the government is at running this like this (<---sarcasm). We're screwed!

  • Report this Comment On June 29, 2012, at 2:20 PM, Forliberty wrote:

    Make no mistake--Obamacare is socialized medicine. Now, in it's early stages, it promotes all of the positive changes--insurance reform, expanded "free" healthcare, etc. But all of these things come with a price--nothing is free. It will all be paid for with taxpayer dollars. Today the cost of this extra care is absorbed by the generosity of doctors and hospitals. Obamacare will end this generosity by paying for it with taxpayer dollars instead.

    The most significant driver of health care costs is utilization. Costs are going up, yes, but that is mostly because of increasing utilization of healthcare services. Obamacare will be powerless to stop this (and, in fact, make it worse by enrolling hundreds of thousands of people who are currently not covered, and thus reluctant to use healthcare services) until the next phase begins, conveniently after the next presidential elections. That phase is government mandated rationing. It is the only sustainable way for the government to control healthcare costs. But you will not see that touted by Mr. Obama. It is much too repulsive to US citizens to ever gain their approval willingly.

    Obamacare will use physicians as the hangmen for the bureaucracy. They (we) will be given the results of government-sponsored outcome studies, and told that yes, we may choose to take care of someone for whom treatment has been deemed "not medically necessary" because of no improvement in long term survival; but the government will not pay for it. So financially your physician will be forced to comply with the government's mandate to not treat. That will be how they ration healthcare, by forcing healthcare workers to swing the axe.

    This undoubtedly will sound fanatical to many, but I recently sat in a conference where the main speaker, an instrumental figure in writing Obamacare, told the physicians in attendance that very thing. When we expressed our indignation with his statements, he told us to "quit whining and get used to it." I suppose that is what they will say to the American public as well.

    If we do not want the government deciding our fate in this manner, we must make our voices heard in November....

  • Report this Comment On June 30, 2012, at 3:56 AM, jonesericr wrote:

    Reading this article one thing stuck out like a sore thumb. When you state that if the US can force Americans to do or buy something simply because they are Americans remember we get taxed in our out of the US just because we are Americans with little wiggle room to get out of it. Any assets held in foreign banks, your salary and/or savings, can be taxed. We had to file the latest form from the IRS this year. So I see a trend of Americans being forced to do many things we haven't had to think about before.

    ej

  • Report this Comment On July 14, 2012, at 2:22 PM, TMFMorgan wrote:

    <<Morgan - thanks for the article and the stimulating debate which ensued. >>

    If you're referring to me, I didn't write the article, fwiw.

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