Obamacare Lives: What You Need to Know

"#SCOTUS upholds #ACA individual mandate."

That was the tweet heard 'round the world this morning from the widely followed SCOTUS Blog.

We'll probably be parsing the words of the Supreme Court's decision for weeks, but it looks like the individual mandate of the Affordable Care Act, also known as Obamacare, has survived.

What's it mean?

Very few expected this outcome. Intrade, an online betting site, put the odds of the mandate being struck down at around 70%. Even staunch supporters of the mandate seemed resigned in recent days to the likelihood that it would likely be repealed.

Simplified, the bill does a few big things:

  • Prevents insurance companies from denying customers for pre-existing conditions.
  • Allows young adults to stay on their parent's insurance until age 26.
  • Limits age-rating, or charging premiums several times higher for older customers.
  • Eliminates lifetime insurance caps and restricts annual limits.
  • Restricts how much insurance companies can spend on non-medical costs (overhead).
  • Mandates that everyone acquire health insurance by 2014 or face a tax, offering subsidies or Medicaid for those who can't afford it.

Here's what's important: According to the Census Bureau, 49.9 million Americans didn't have health insurance in 2009. Part of that is due to the weak economy; most of those without health insurance have a very low or nonexistent income. But a lot is due to soaring costs that have put insurance out of reach for the gainfully employed. According to the Kaiser Family Foundation, 69% of businesses offered workers health insurance in 2000. By 2009, that number had dropped to 60%. It's almost certainly lower today. Our health-care system doesn't work for far too many Americans, which likely explains why most of the policies outlined above are pretty popular. Most, that is, except the mandate to buy insurance:

Source: Kaiser Family Foundation, April 2012.

But there's a problem here. Without a mandate, most of the popular provisions of ACA wouldn't work. Last week, health-care reporter Sarah Kliff wrote in The Washington Post about what happened when Washington state made it illegal for health insurers to deny customers for pre-existing conditions (popular) but didn't make it mandatory to buy health insurance (unpopular):

In 1993, Washington state passed a law guaranteeing all residents access to private health-care insurance, regardless of their health, and requiring them to purchase coverage. The state legislature, however, repealed that last provision two years later. With the guaranteed-access provisions still standing, the state saw premiums rise and enrollment drop, as residents purchased coverage only when they needed it. Health insurers fled the state and, by 1999, it was impossible to buy an individual plan in Washington -- no company was selling.

Kliff mentioned one customer who told her insurance company that she "very much appreciated our excellent service [and] that she would certainly pick our plan again when she became pregnant." That doesn't work. A mandate gets around the problem by forcing healthy people to pay into the system, not just the sick.

So, who wins here?

The measuring of political wins and losses misses the point altogether. The winners here are the nearly 50 million Americans who don't have health insurance. They're the majority of personal bankruptcy cases linked to medical bills, and those who couldn't quit their job because they can't afford to lose employer-provided coverage.

Health insurers might be seen as losers -- shares of UnitedHealth (NYSE: UNH  ) , WellPoint (NYSE: WLP  ) , and Cigna (NYSE: CI  ) were all down big this morning -- but it's still entirely unclear how the bill will affect their business over the long haul. On one hand, there are a raft of new rules to comply with. On the other, they'll eventually see a flood of new customers effectively mandated to buy their product. First-day knee-jerk reactions rarely reflect the true impacts of big events.

This isn't the end of the story, of course. Mitt Romney has vowed to repeal the ACA if elected president. One of the biggest complaints about the ACA is that it causes uncertainty. No one knows what might happen next, or what health-care costs will be a year or two from now. Alas, that hasn't gone away.

Fool contributor Morgan Housel doesn't own shares in any of the companies mentioned in this article. Follow him on Twitter @TMFHousel. The Motley Fool owns shares of WellPoint. Motley Fool newsletter services have recommended buying shares of UnitedHealth Group and WellPoint. Motley Fool newsletter services have recommended creating a diagonal call position in UnitedHealth Group. The Motley Fool has a disclosure policy.

We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. Try any of our Foolish newsletter services free for 30 days.


Read/Post Comments (194) | Recommend This Article (242)

Comments from our Foolish Readers

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  • Report this Comment On June 28, 2012, at 12:46 PM, whereaminow wrote:

    I'm glad that the Gang on 9 has finally ruled that a fine is a tax. When you do your articles going forward explaining that we need to raise America's tax burden be sure to include fines in your analysis of the current tax rate.

    David in Liberty

  • Report this Comment On June 28, 2012, at 1:10 PM, DoctorLewis4 wrote:

    Morgan is right. It was a good day for all Americans.

  • Report this Comment On June 28, 2012, at 1:40 PM, famiglia112 wrote:

    @DL4 Except healthy Americans

  • Report this Comment On June 28, 2012, at 1:58 PM, whereaminow wrote:

    LOL, yep. A good day for Americans who eat unhealthy, cancer/obesity/diabetes causing high carb/high sugar diets promoted by the USDA and need access to expensive medical care provided by the taxpayer (er, fine-payer?)

    Eh, what else is new. Buy gold and silver and at least you rob the welfare state of its ability to devalue your savings to pay the sure-to-become-even-more-unsustainable costs of the government-big business partnership.

    And eat a anti-government high-fat, low-to-no carb diet, so you don't have to wait in these god awful medical facilities to get "treatment" for your USDA diet related diseases.

    David in Liberty

  • Report this Comment On June 28, 2012, at 1:59 PM, rhealth wrote:

    "Mitt Romney has vowed to overturn the ACA if elected president."

    Yeah what about that? Obama spends his whole career getting this through and the next Republican that gets in abolishes it?! Would he not need the court to overturn their decision?

  • Report this Comment On June 28, 2012, at 2:13 PM, mdk0611 wrote:

    No, he would not need the court. It could be done by act of Congress.

  • Report this Comment On June 28, 2012, at 2:14 PM, TMFMorgan wrote:

    Wanted to mention something about this paragraph lest someone calls it out:

    "The measuring of political wins and losses misses the point altogether. The winners here are the nearly 50 million Americans who don't have health insurance. They're the majority of personal bankruptcy cases linked to medical bills, and those who couldn't quit their job because they can't afford to lose employer-provided coverage."

    Just watched Obama's speech and he says something nearly identical. This is a complete coincidence. I wrote it before his speech.

    -Morgan

  • Report this Comment On June 28, 2012, at 2:34 PM, TMFMorgan wrote:

    Important part of today's ruling not mentioned here:

    http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/06/28...

  • Report this Comment On June 28, 2012, at 2:48 PM, mtf00l wrote:

    @whereaminow

    How do you really feel? I'm sure I've asked you that before... :D

    Regarding the A.C.A, what's been written, what's been said and what will be have little in common.

  • Report this Comment On June 28, 2012, at 2:50 PM, mtf00l wrote:

    @Morgan,

    Presidential speach writting could be an avenue for growth... :D

  • Report this Comment On June 28, 2012, at 2:56 PM, Acesnyper wrote:

    @ Morgan, sure he didn't steal it?

    Days like this I really feel like saying screw it and adopt the "we president now" mindset, eating 42 boxes of cookies and asking for food stamps. While I'm at it I'll smoke since the taxes are gonna cover me anyway.

    Disgusting. I'm half tempted to check search histories and see how much "foreign visas" got searched today.

  • Report this Comment On June 28, 2012, at 2:57 PM, TMFMorgan wrote:

    <<Morgan, sure he didn't steal it?>>

    Ha, yes. It was reported early this morning that he had 4 different speeches ready to do.

  • Report this Comment On June 28, 2012, at 4:16 PM, Acesnyper wrote:

    Just making sure you were going to get credit if due, cheers!

  • Report this Comment On June 28, 2012, at 4:39 PM, blairsp wrote:

    Politics aside what would the "average" working, already insured middle age person do as next steps in response to this passing?

    I've worked with people around the world.Many say the level of care is sub-par, taxes regularly increase to pay for it and they have trouble getting jobs due to employer cuts.

    These same people find themselves working elsewhere in the world than their home country or they start a small business and become self employed.

    I'm not sure where the country will go but taxing working people to pay for non-working health care coverage really sounds like slippery slope we as a nation should avoid.

    Thoughts?

  • Report this Comment On June 28, 2012, at 5:35 PM, eltabor wrote:

    Hello

    The judges must have read a good portion of the bill and found the part about not paying the penalty will not be punishable by imprisonment, garnishment, liens, foreclosures, or a fine. Liberals hate the word mandate and as the bill progressed any recourse for the IRS to collect was completely stripped away. There really is no mandate, just a media illusion(again) of one. That still will not solve the problem of the millions of Americans still not covered because they can't afford insurance, which by the way is the very reason the fine was stripped from the bill. MEDICARE FOR ALL is the way to go and it works. Ask your parents and grandparents they have personal insight on this.

  • Report this Comment On June 28, 2012, at 5:39 PM, evn wrote:

    I'm healthy now, I have health insurance, why should I care about anybody else? Seems reasonable.

  • Report this Comment On June 28, 2012, at 5:44 PM, dj1962 wrote:

    I say it doesn't look good for the health insurance industry. Even with the individual mandate, they are all still going to go out of business with all the price controls and mandated coverage.

  • Report this Comment On June 28, 2012, at 5:45 PM, TMFMorgan wrote:

    dj1962,

    What "price controls" are you referring to?

  • Report this Comment On June 28, 2012, at 5:47 PM, Plinkon wrote:

    The primary argument I hear when people try to denounce the ACA is something along the lines of: "why should I have to pay my hard-earned taxes to support some other shmoe's health care?". A slightly different, but fairly related comment goes something like: "If people want to eat unhealthily and give themselves diabetes, they should have to pay for their own health care".

    Neither of these comments is unfair. Indeed, in a perfect, predictable world everyone would be responsible for only their share of their health care costs. Recognize, however, that in a perfect, predictable world, there would be no need for something called "insurance"! Indeed, the whole idea of "insurance" is based on the premise that we can't predict everything, that good people will get sick, that healthy people will get injured.

    In this regard, I find the arguments against ACA to be not just selfish (which is a given - whether right or wrong, it is by definition a selfishly-based argument), but also short-sighted in two ways:

    First: it's somehow based on the premise that the currently healthy person that takes care of themselves will never need health care.

    Second: it assumes, as a blanket truth, that those individuals who are uninsured are highly unhealthy.

    While anecdotal evidence can likely be found to support both of these assumptions, as a general rule neither of them will be able to hold true. And so, in the end, we really just come back to the first argument, which is "why should I help pay for some other shmoe's health care?".

    It's a reasonable question. If you're inherently a selfish individual.

  • Report this Comment On June 28, 2012, at 5:49 PM, Plinkon wrote:

    @ evn: it is completely reasonable! It's just terribly, humiliatingly, selfish.

    Then again, you don't seem humiliated at all. Proud, almost. Strange.

  • Report this Comment On June 28, 2012, at 5:53 PM, TMFMorgan wrote:

    <<First: it's somehow based on the premise that the currently healthy person that takes care of themselves will never need health care.>>

    Exactly. Those who say they don't need health insurance because they take care of themselves don't seem to comprehend that accidents and surprises are, by definition, out of their control. I forget who, but someone recently wrote, "as long as there is cell division there will be cancer."

    -Morgan

  • Report this Comment On June 28, 2012, at 5:55 PM, eltabor wrote:

    Plinkon you are dead on. We are all in this world together and to look out for each other. That is why we should also become a humanitarian super-power instead of a war super-power.

  • Report this Comment On June 28, 2012, at 5:57 PM, Loxly wrote:

    In a previous fool article it was stated that there could be a decline in the jobs held outside of government to manage this mess. For some that might be true but Wellpoint, if you drill down into their business (National Government Services), is a major provider of IT services to CMS and NIH, so their business might expand on one end even if it decreases on the other.

  • Report this Comment On June 28, 2012, at 6:00 PM, Viking70 wrote:

    Politics aside, can someone explain how the bill is going to be paid? If 40% + of Americans are effectively paying no tax, why does the individual mandate entice them to buy health insurance? A 1% fine of $0 is ... $0. So requirement to buy health insurance or face a fine based on your tax bill is moot point, I would think. Maybe I am not understanding this, but it sure seems that there is going to be an unfunded liability out there that someone is going to have to pay. Based on our history I have a pretty good feeling who is going to be footing the bill.

    I agree that the winners are people with pre-existing conditions and those who exceed their annual caps. I also agree that those limitations need to be overcome, but I am not sure that the ACA is the correct method. In fact, I am quite sure it is not. Any bill that required sweeteners for some states in order to get it passed and was tagged with the quote "we need to pass it so we know what is in it" is not off to a good start.

    The government should be involved in helping fix the health care system. Apologies to my conservative friends, but the free enterprise system was not working for folks not covered by an employer plan. However, I am a proponent of fixing the problems with the existing system before implementing changes--not saying that changes weren't/aren't needed, but until you fix the existing problems of fraud and waste in the current system along with tort reform, you can't really know the best path to fix the problem.

  • Report this Comment On June 28, 2012, at 6:02 PM, Turfscape wrote:

    How did we ever get to this assumption that the only people who use the health care system in the country have somehow brought it on themselves through poor choices?

    Smart, healthy people who eat well need health care quite frequently. But, I guess it's easier to play this "us against them" game where we can all blame someone else for our collective shortcomings.

  • Report this Comment On June 28, 2012, at 6:04 PM, TMFMorgan wrote:

    <<If 40% + of Americans are effectively paying no tax, why does the individual mandate entice them to buy health insurance? A 1% fine of $0 is ... $0>>

    Ezra Klein explains:

    "If their income is less than 133 percent of the poverty line, they receive Medicaid (unless their state rejects federal Medicaid dollars for the expansion, something the Court made it easier for them to do). If their income is between 133 percent and 400 percent, they receive some level of subsidies"

  • Report this Comment On June 28, 2012, at 6:06 PM, Plinkon wrote:

    @Viking

    I think your points are well-made and on-point. There is no question that we should be working to fix things like fraud, waste and tort-reform.

    At the same time, the argument that we should do nothing until those issues have been taken care of is a potentially problematic one. I think you are on the up and up, but some who make that argument are really just using it as a stall tactic - a way to keep the status quo for as long as possible. And since they can't claim that the system isn't broken, they claim instead that it's not "the right time" to initiate a fix.

    Again, I'm not claiming that that's what you're trying to do. And indeed, I agree with you that fraud/waste needs to be reigned in. But somewhere, somehow, a first step needs to be made. Perhaps you're right that ACA isn't the absolutely best or most optimal first step...but it's a first step, nonetheless, which is better than no step at all.

  • Report this Comment On June 28, 2012, at 6:07 PM, actuary99 wrote:

    @Plinkon

    That comment was beautiful. I predict healthcare costs and analyze healthcare data for a living. You're spot on.

    The idea that the uninsured population is uninsured because most are unhealthy is... wrong.

    COBRA & HIPAA make it especially difficult for insurers to turn someone down for coverage due to health reasons. Additionally, most states have high risk pools that unhealthy people have as basically their only option for coverage.

    Additionally, there's a high correlation (I would speculate causation in both directions) with being unhealthy & being poor - those unhealthy people are already covered by Medicaid.

  • Report this Comment On June 28, 2012, at 6:10 PM, golfchoice wrote:

    I can't believe what you people are saying. The more liberal our country becomes, the more socialist we'll become. The more socialist we become, the more it will cost ALL of us to live here. Has anybody seen what socialism has done to Europe? What about Greece and Spain? Sure, there are a lot of unemployed people in those countries, and yes, they all still have health insurance. But they can't get jobs because the companies can't afford to hire them to pay for the socialist government that they all have been rioting about being taken away because of the austerity measure the EU has been imposing on them. Do you liberals really want to have a country like Greece or Europe? Not me.

  • Report this Comment On June 28, 2012, at 6:19 PM, lesailes wrote:

    Speaking as a foreigner, welcome to the rest of the world. Most comparable countries require universal coverage for the most blindingly obvious reasons. Just a couple of points - US insurance premiums exceed those I am am familiar with by 6 times and travel insurance for when I visit the US is ludicrously expansive compared to other countries.

    Oh and for the socialism-haters the best most customer service focussed organisation I have dealt with in Australia is the government run coverage provider Medicare - instant personal service and overnight refunds.

    You can do it too!

  • Report this Comment On June 28, 2012, at 6:19 PM, CommanderFlipper wrote:

    This was an excellent article -- except for the frequent references to "Obamacare" the right wing's dismissive, disrespectful slur which goes along with their misinformation.

    What many people who are alreay insured don't realize is that they are ALREADY paying for the uninsured. When an uninsured goes to the emergency room and can't pay, the rest of us pay through increased premiums to make up for those who can't pay.

    When these uninsured become insured they will be able to go to the doctor for preventive care as well as at the first sign of a problem -- they won't have to wait until it is so bad they have to go to the emergency room. The availability of preventive care will go a long way to reducing costs.

    We fools are fearful when others are greedy and greedy when others are fearful. That's fine for our porfolios, but we should not carry the greed over to preventing children, for example, from getting health care -- under many existing policies they are turned down when they get sick. Also, many adults lose their insurance under existing circumstances because they have the temerity to become ill. That could happen to some of us Fools, including those who now are still opposed to the ACA.

    As far as the uncertainty is concerned, there would be none if the Republicans weren't threatening to repeal the ACA. As Maria Bartiromo said on CNBC today, the SCOTUS decision brings clarity. But that clarity will disappear once the repeal battle begins. So there is a certain amount of appropriate self interest in supporting the new law.

  • Report this Comment On June 28, 2012, at 6:21 PM, TMFMorgan wrote:

    <<Has anybody seen what socialism has done to Europe? What about Greece and Spain>>

    That's far more about an aging population and an inane currency structure than it is universal health care. The US government spends more on health care per capita than almost all European countries -- and we only insure our elderly and poor, while they insure everyone:

    http://g.foolcdn.com/img/editorial/healthspending.png

  • Report this Comment On June 28, 2012, at 6:23 PM, TMFMorgan wrote:

    <<This was an excellent article -- except for the frequent references to "Obamacare" the right wing's dismissive, disrespectful slur which goes along with their misinformation.>>

    As the Motley Fool mentioned last week, "ObamaCare" is a term used by the Obama administration themselves:

    http://www.fool.com/investing/high-growth/2012/06/27/where-o...

  • Report this Comment On June 28, 2012, at 6:26 PM, Chubu wrote:

    They will receive Medicaid if the states decide to expand their programs (in Virginia this program pays primary care providers around 30-40% under Medicare and other payors which provides zero incentive for physicians to accept medicaid if they can build their practice via other means).

  • Report this Comment On June 28, 2012, at 6:30 PM, Viking70 wrote:

    @Morgan,

    I appreciate the clarification, but, sorry, I don't quite get it because I am not quite where the people that are effectively paying no tax fall within the guidelines laid out by Ezra Klein that you provided.

    "If their income is less than 133 percent of the poverty line, they receive Medicaid (unless their state rejects federal Medicaid dollars for the expansion, something the Court made it easier for them to do). If their income is between 133 percent and 400 percent, they receive some level of subsidies"

    Are we assuming (ohhh, I hate that word) that if income is greater than 400% of the poverty line that they are the paying taxes (i.e. effective tax rate is greater than $0)? Not trying to be difficult, but this just scares the crap out of me. Our middle class has been in decline for awhile it seems to me. I fear that as more people fall into the category of 133% PL < income < 400% PL, the more subsidies the government will be on the hook to pay for. The answer is, of course, we need to reverse the middle class decline, but that isn't really the issue at this point.

    I have no evidence of this, but it seems to me that most people/families, would have health insurance if the could afford it or have it through their employers. Not all, I know, but the vast majority I would think. So, we are adding millions of people to the insurance rolls (a good thing), but who is paying the bill to add these folks? I am just not seeing that the additional people/families that pay their own way (or pay the "fines") adds up to enough $$ to pay for the newly insured. Please note, I have no numbers to support this, which is why I am asking.

  • Report this Comment On June 28, 2012, at 6:37 PM, whereaminow wrote:

    ----->> but who is paying the bill to add these folks? <<----

    ROFL

    If you can't spot the sucker in your first half hour at the table, then you ARE the sucker.

    Good times.

    David in Liberty

  • Report this Comment On June 28, 2012, at 6:40 PM, eltabor wrote:

    if Obama is a socialist he is a lousy one

  • Report this Comment On June 28, 2012, at 6:41 PM, Plinkon wrote:

    @golfchoice

    The problem with your argument isn't that the evidence doesn't support it, it's that you've very selectively cherry-picked your evidence to ensure that it does.

    It's true that the southern European countries are in financial trouble. However, there are many other "socialist" countries that are not having similar problems. In fact, there are many more of them: Germany, Canada, Finland, Sweden, Denmark, Norway, England, Japan, Australia. The list goes on.

    That, of course, doesn't mean that "socialism" didn't cause the financial difficulties in the countries you're referring to. It just means that the "evidence" you've tried to put forth to support the claim that it did doesn't hold water.

  • Report this Comment On June 28, 2012, at 6:53 PM, actuary99 wrote:

    "Politics aside, can someone explain how the bill is going to be paid?"

    A combination of direct and indirect tax increases. Here's how it works:

    (1) More people will have access to healthcare coverage. Therefore more services will be consumed. Therefore overall costs will increase. Period.

    (2) The federal government will directly fund the costs due to increase in Medicaid eligibility. I think they're also funding some/all of the subsidies.

    Indirect taxes:

    (1) Employers with half-ass healthcare plans or no healthcare plans will have to decrease wages or fire people to pay for the increased costs. Workers will pay for this.

    (2) When costs grow to quickly the govt can, pretty much at any time, decrease the amount paid for services covered by government insurance. Alternatively they'll increase reimbursement per service at an artificially slow rate. Providers & physicians pass this cost on by increasing fees charged to private payers (i.e., the evil insurance companies, gee, why do they keep raising premiums so much?).

    (3) The law has provisions to charges extra taxes and fees to pharmaceutical companies and health insurers. Surprisingly, this doesn't magically decrease the cost of capital. Therefore these companies will raise premiums & price per drug to remain profitable. All the while Democrats can pretend (and maybe even believe) they're sticking it to the man! The man being evil health insurance companies and evil pharma companies. As someone who works in this industry, the pharma companies actually ARE kind of evil, yet amazingly they come out of health reform pretty much unscathed.

    (4) Young healthy males. Healthcare costs more for young females and all old people. Even before PPACA, there were limitations in many states on a health insurer's ability to charge premiums commensurate with expected costs based on these characteristics.

    Therefore young healthy males were already subsidizing females and old people.

    Now "age bands" for commercial insurance premiums are limited to 3:1. A 60-64 year old person costs about 5-6x as much as a 20-29 year old male. Young males (and young females to a lesser extent) now must be charged higher premiums to make up for this difference.

    This is part of the law I find particularly disgusting. Older, pre-Medicare eligible people should be earning the highest incomes in their lives, yet someone* felt that young people, who have built up no assets and have less earning power, should subsidize their costs.

    *It has been suggested and makes complete sense that the AARP would not endorse the bill without this age-band provision. In my experience in working with healthcare insurers and providers, this is more supporting evidence that the AARP is ran by the scum of the earth.

    (5) Loss Ratio Requirement - Insurers must now spend a minimum % of premium on benefits. This is one of the few parts of the law that WILL actually decrease healthcare costs.

    (6) Other ways (but the above is most of it).

  • Report this Comment On June 28, 2012, at 6:59 PM, CaptainHaiku wrote:

    "Just watched Obama's speech and he says something nearly identical. This is a complete coincidence. I wrote it before his speech. "

    suuuuure . . . .

    :)

  • Report this Comment On June 28, 2012, at 7:08 PM, Viking70 wrote:

    @Plinkon,

    Unfortunately, you are probably correct in that while ACA is not ideal it was a necessary first step because our politicians were doing nothing about the fraud, waste and abuse in our healthcare system nor where they doing anything substantive about the spiraling health care cost. They had years to address this issue before ACA was signed and did nothing. They have had almost two years since ACA was signed and have still done nothing about the fraud, waste, abuse and tort reform. Instead our politicians argue constantly about whether ACA is the proper path to take, and ignore the easy fixes that would help everyone but the crooks and not cost any of us a dime more in taxes, fines, fees, etc.

    I have gradually become more disenchanted by our government over the past few years. It is about who wins and not about what is best for all of us.

  • Report this Comment On June 28, 2012, at 7:08 PM, Snertie wrote:

    Since my family is healthy and the "tax" is a fraction of what my insurance is, and just like in previous schemes I can sign up after I actually get sick, going uninsured seems like the way to go.

    Of course, this is only until the entire system collapses (which ObamaCare is designed to accelerate) and it's all replaced with a "single payer" system, which is what they really want.

    Then, my income taxes will shoot way up to make up for the premiums I used to pay. After my home is paid off, health care will be my largest monthly expense. In that case since health care will now be "free" and working nearly pointless, I'll be able to retire in my 50s, just like they do in Greece.

  • Report this Comment On June 28, 2012, at 7:11 PM, Viking70 wrote:

    @actuary99,

    What you identify is exactly what I am afraid of.

  • Report this Comment On June 28, 2012, at 7:12 PM, nomad33 wrote:

    I am a dual US- Canadian, living in Vancouver for over 42 years. Health care has never been an issue. My costs to insure a family of four are less than $150/month- excess options for travel, dental etc might cost another $200/month. Of course there are some problems with wait times for certain procedures, but there are always options to buy alternative service. If we have "socialized" medicine then I am all for it. The US cannot stand the thought of "socialism", which merely means we support each other, and therefore have medical costs well in excess of twice the Canadian model. A properly run medical system will lower everyones costs- Canada can certainly provide some guidance to the best parts of a good system..

  • Report this Comment On June 28, 2012, at 7:13 PM, actuary99 wrote:

    ----->> but who is paying the bill to add these folks? <<----

    "ROFL

    If you can't spot the sucker in your first half hour at the table, then you ARE the sucker.

    Good times.

    David in Liberty"

    Dead right on that one, but you're not rolling on the floor laughing.

    The world is moving further from your ideological viewpoints, and your impressively eloquent form of whining will become more and more necessary (though in no way less annoying). I guess it's possible you think a complete economic implosion is inevitable and that after that economic policy could conform to your ideology. For your sake and the sake of the people being subjected to your whining, I hope you're right. Just seems unscrupulous to be a cheerleader for an economic meltdown, and also kind of effeminate, because you're a cheerleader and all.

    Have you ever considered, in a practical sense, about what could improve within the context of reality? ...As opposed to acting like there's even a remote chance reality will conform to your libertarian wonderland overnight.

  • Report this Comment On June 28, 2012, at 7:17 PM, shsscar wrote:

    we're screwed

  • Report this Comment On June 28, 2012, at 7:23 PM, fawncee2 wrote:

    This is disgusting. Investors, capitalists I presume, arguing for socialism. cleaning the barf off my shoes

  • Report this Comment On June 28, 2012, at 7:50 PM, efbeau wrote:

    There is one thing missing in all the comments here.Why does the medical system charge whatever they want for procedures?

    When you go to the doctor and pay out of pocket you quickly learn about excessive charges.Though I will say it is still cheaper than paying for medical coverage that never pays in full,outrageous deductibles,etc.The medical industry has the politicians in their pocket the insurance companies lost.The insurance companies were being gouged by the medical industry for decades,inturn they gouged the consumer.

    Here is something else to think about; does anyone question why Supreme court justice Sonia Sotomayor gets away with not excusing herself from this case? She was involved in the research and writting the Health Care Law. When I was growing up this was called a "conflict of interest".Obviously she was voting for it. This not a free Republic at work.

    You young pups out ther really need to pay more atention to what is actually happening in plane site.

  • Report this Comment On June 28, 2012, at 7:54 PM, mythshakr wrote:

    So, Romney says he's going to repeal Obamacare on day one. What, he thinks he can write down "I hereby repeal the ACA" and sign it and it shall be so?

    Unhealthyness is a result of poor health choices? So, Downs Syndrome, Lou Gehrig's disease, type 1 diabetes, MS, Parkinsons, DUI and other vehicular type trauma/etal victims and pregnancy are the result of poor health choices?

    So, China must not stand an economic chance against America because they are Socialists?

    Obviously the borders of Fantasyland do extend outside the park.

  • Report this Comment On June 28, 2012, at 7:58 PM, billr44 wrote:

    "The winners here are the nearly 50 million Americans who don't have health insurance."

    How can this be true if you even spend a moment thinking about it? Those who do not have health insurance do not suddenly get health insurance, they have to buy it.

    They have to buy it unless, that is, they are covered by Medicaid or Medicare. If you are not covered by Medicaid or Medicare, then you must buy insurance, and that buying helps pay for those on Medicaid.

    How is it helpful to have to pay for expensive health care insurance when the economy is so poor and jobs are so scarce? This is the wrong time for a tax on the order of ten thousand or more a year.

    I need to eat every day. I need shelter every day. I need health care once in while. With my income down to lows I have never experienced before, why is this a good time to mandate that I buy something I may not want? I may want to chose eating over going to the doctor. Who is entitled to tell me otherwise?

    Nothing in Obamacare cuts the cost of medical care. Obamacare says it will cut $500 billion from Medicare. Maybe, but Congress has never had the guts to do so.

    If Congress does does cut Medicare, then who ends up paying the difference? Will the doctors eat it? No. Will the hospitals eat it? No. I will eat it, and all others like me will eat it.

    Obamacare will cause my medical care expenses to rise and rise greatly.

    Why anyone would parrot the party line of Obamacare is beyond my understanding.

    I would have thought Obamacare is contrary to the idea of limited government and a free people upon which America was founded. The Supreme Court sees it otherwise. I really don't care. It's still a bad law whether it is constitutional or not.

  • Report this Comment On June 28, 2012, at 8:01 PM, chris293 wrote:

    Who really wins here, the poor young people that are too healthy to need this insurance cost place on them, or those nations that will love this country go broke. Especially, our politicians that seem to enjoy socialist, religious,or a government system which benefit other nations.

    And I am sick as hell of hearing that the United States is the world's richest nation. Any number of European, Middle East, Asian nations are richer and without the endless debt we have piled up.

  • Report this Comment On June 28, 2012, at 8:36 PM, Cruiser55N wrote:

    No, what it does is make the sensible, affordable high deductible insurance I buy illegal. Now I'm supposed to buy "insurance" that covers every little expense as well as preexisting conditions (note to the financially illiterate, you can't insure certainties).

    As usual DC dimwits are imposing their stupidity on us through coercive force.

  • Report this Comment On June 28, 2012, at 8:38 PM, chapramsey wrote:

    I love what *eltabor* wrote.....

    MEDICARE FOR ALL is the way to go and it works.

    It does? Is medicare that entitlement that is cutting pay for doctors and hospitals....that is grossly underfunded? Gee....how are we going to pay for this great system called Medicare? I know, *tax the rich*! They are greedy and don't deserve all that money they have anyway.....

    Chap2189

  • Report this Comment On June 28, 2012, at 8:47 PM, Zombie111 wrote:

    I don't understand the fear about "socialist medicine". Our country has basic free hospital treatment for everyone, but you can buy extra health insurance if you want. It isn't perfect but it doesn't bankrupt us. A relative of mine needed a hernia removed, 2 weeks later it was done for free. It was his return on taxes. Insurance companies are one more layer clipping the ticket.

    Maybe if the USA spent less than 54% of its taxes on the Pentagon, it could afford universal health care.

    Not every illness is the result of poor lifestyle choices, although I agree that these are becoming more prevalent due to modern lifestyles. My mother-in-law led a healthy lifestyle but it didn't stop her getting a degenerative neurological disease.

  • Report this Comment On June 28, 2012, at 8:52 PM, TMFMorgan wrote:

    <<A relative of mine needed a hernia removed, 2 weeks later it was done for free>>

    It may have been free to him, but someone paid for it.

  • Report this Comment On June 28, 2012, at 9:13 PM, Bert31 wrote:

    "49.9 million Americans didn't have health insurance in 2009. "

    In 2007 the nuber was about 45.7 million and here are some interesting facts about that:

    11 million were eligible for medicare/SCHIP but not enrolled -

    9.7 Million were not U.S. Citizens. Make having coverage a requirement to entry.

    4.7 million were college university students-relatively inexpensive group to insure

    9.1 million had income >$75,000 year and could afford at least catastrophic coverage but chose not too.

    Remaining uninsured 13-16 million.

    Any discussion of effective health policy requires full disclosure of the composition of the uninsured.

    "The winners here are the nearly 50 million Americans who don't have health insurance."

    Have you considered why they don't have insurance? Not really. The majority could have had coverage if they wanted it before Obamacare.

    "They're the majority of personal bankruptcy cases linked to medical bills, and those who couldn't quit their job because they can't afford to lose employer-provided coverage."

    Then perhaps Obama should have addressed bankruptcy laws instead.

  • Report this Comment On June 28, 2012, at 9:37 PM, TMFAleph1 wrote:

    <<Have you ever considered, in a practical sense, about what could improve within the context of reality? ...As opposed to acting like there's even a remote chance reality will conform to your libertarian wonderland overnight.>>

    Oh no you didn't.

    [Taking out the popcorn]

  • Report this Comment On June 28, 2012, at 9:46 PM, johnadams620 wrote:

    Good thoughts all. Have to say this issue is a damned whether we do or don't scenario.In a relatively free society if you dictate morals or mandate sacrifice,you instantly add numbers to the underground.This process could be perceived (Morgan) as cell division turning into cancer.Never will everyone be on the same page.Fair?If fair means all equal,all the time,then fair is undone by it's own requirements.Somebody is always getting the short straw and someone will be living in a penthouse made of long straws.Rich man should give more of what he has to the poor man,this moves them both to center.Who do you think likes this equality best?Sorry to ramble or bore you.Personally I think that when our species stopped being "hunter-gatherers" and settled into groups,towns,cities,they discovered ownership! So began the descent of mankind...J

  • Report this Comment On June 28, 2012, at 9:47 PM, whereaminow wrote:

    LOL Alex. You know that one ain't even worth it. I am going to resist tackling his little strawman.

    David in Liberty

  • Report this Comment On June 28, 2012, at 9:47 PM, TMFGortok wrote:

    Getting health 'insurance' for a pre-existing condition is like trying to get Fire Insurance for my house after it's burned down.

    We have many problems, and the ACA will not fix them. As a medical doctor of 40+ years said recently: The patient is going to be bad off whether or not the ACA is upheld.

    However, one thing we can all be certain of: The welfare/warfare state will crumble. It's just a matter of when.

  • Report this Comment On June 28, 2012, at 10:07 PM, wrenchbender57 wrote:

    First of all, under our old system we pay more than any other country in the world and get less back for it, per capita. Not sure how anything could but be an improvement over that? Granted, people that have unhealthy habits should pay a penalty. OTOH, some diseases strike even healthy people that take good care of themselves. Why should they have to go bankrupt or be denied care? Lastly, Obamacare is a political term. Typically used by Conservatives, Republicans and Tea Party folks as a disparaging term for the AHCA. Would be nice to see the bill called by it's real name rather than the slander term that those against it are using.

  • Report this Comment On June 28, 2012, at 10:14 PM, wrenchbender57 wrote:

    The real answer to the health care problem is probably Socialized medicine run by the government. Hate to say it but probably true. Most other countries have gone this route and in many of these the system seems to work pretty well. Their costs are lower, on average, and the quality of care is better, on average than it is here in the USA. Research the statistics. I think the mistake the Dems made with trying to appease the Conservatives by including the insurance companies instead of excluding them. After all that, the Repubs did not vote for the final bill anyway. Though the final form probably did swing a few conservative Demo votes.

  • Report this Comment On June 28, 2012, at 10:30 PM, RocketSciGuy wrote:

    It was a great day for Socialism. Period.

  • Report this Comment On June 28, 2012, at 10:58 PM, whereaminow wrote:

    Socialism? Perhaps. It's definitely Fascism, though. You will get taxed so a small group of government selected insurance companies gets a guaranteed revenue, all part of a law their lobbyists wrote and that not a single politician read. The marriage of big government and big business. Definitely Fascism. However, there is some welfarism inherent as well, obviously, since tax payers with low risk characteristics will essentially bankroll those who have high risk characteristics.

    The worst argument I see here is "this is a step in the right direction!"

    How do you know that? How is stepping towards total government control the right direction?

    Let's look back for a second. For the highly politicized, government became involved in health care yesterday. For the rest of us, we know that government has been entrenching itself more and more for almost a century, and passed a huge overhaul in 1973. Wasn't THAT a step in the right direction? If not, why?

    Why was the Health Maintenance Organization Act of 1973 a step in the WRONG direction, but that this particular act is suddenly a step in the RIGHT direction?

    Morgan, can you explain this? Anyone else care to answer this one?

    Alex, get the popcorn.

    David in Liberty

  • Report this Comment On June 28, 2012, at 11:02 PM, wrenchbender57 wrote:

    @billr44: You make a good point. Why buy something you may not need except once in a while? The answer, of course, is that if you don't buy health insurance and get sick the rest of us will likely pay your bill for that. How is that you ask? Well, in my city everyone that has an urgent need and goes to the emergency room will get treated. It matters not if they have health insurance or not. When all is said and done someone pays the bills for these folks. Either in higher costs for the rest of us, government subsidies or some other hidden funding that we all pay for. So, you, by NOT buying health insurance until you need it are part of the problem NOT part of the solution. It galls me that folks don't see this side of this issue.

  • Report this Comment On June 28, 2012, at 11:03 PM, Viking70 wrote:

    @ir0b0t,

    <<Maybe if the USA spent less than 54% of its taxes on the Pentagon, it could afford universal health care.>>

    Really? Where did you pull this statistic from or do I already know?

  • Report this Comment On June 28, 2012, at 11:08 PM, skypilot2005 wrote:

    On June 28, 2012, at 8:47 PM, ir0b0t wrote:

    "I don't understand the fear about "socialist medicine". Our country has basic free hospital treatment for everyone, but you can buy extra health insurance if you want. It isn't perfect but it doesn't bankrupt us. A relative of mine needed a hernia removed, 2 weeks later it was done for free. It was his return on taxes. Insurance companies are one more layer clipping the ticket.

    Maybe if the USA spent less than 54% of its taxes on the Pentagon, it could afford universal health care.

    Not every illness is the result of poor lifestyle choices, although I agree that these are becoming more prevalent due to modern lifestyles. My mother-in-law led a healthy lifestyle but it didn't stop her getting a degenerative neurological disease"

    I don’t know what country you live in but, if it is Canada or in Europe, you should be grateful for the money we spend on defense. Otherwise, you would now be speaking Russian or German.

    Most Democracies have and continue to benefit from our protection while providing relatively little funds for their own protection. Many of us have been killed or permanently injured protecting your freedoms.

    In my opinion, you are ungrateful and disrespectful of all of us that have served honorably.

    As far as Obama Care. I am against it. Good luck to those of us waiting in line for care while the lawyers still pick our pockets.

    Sky

  • Report this Comment On June 28, 2012, at 11:20 PM, whereaminow wrote:

    ---> Many of us have been killed or permanently injured protecting your freedoms. <----

    If that's true, why do I have less freedom now than I did before? Why does America have less liberty today than it has ever had?

    Hmmmm......

    David in Liberty

  • Report this Comment On June 28, 2012, at 11:23 PM, wrenchbender57 wrote:

    Capitalism is a great thing and we derive many benefits from it in this country. But, it is certainly not perfect. Democracy is not perfect either. Just better than all the others. Leaving health care to Capitalism alone is a BAD idea. Why? Many reasons. Older people would pay more. Sick people would pay more. Folks with cancer, etc. could not afford treatment. The list goes on. So the arguments that our freedom is threatened or that a Socialist system is not the best for our country are not very relevant. That horse left the barn long ago. If that were not true we would not have Social Security, Medicare, Medicaid, Unemployment insurance, etc.. Our country has taken the best of a Democratic, Capitalist system and supplemented it with Socialist type of reforms as needed to make it more humanistic than it would be otherwise. For the most part it seems to work well. Though I would agree it needs tweaking from time to time to keep it working.

  • Report this Comment On June 28, 2012, at 11:36 PM, whereaminow wrote:

    -----------> Older people would pay more. Sick people would pay more <----------

    At some point in your life, wouldn't you be young and pay less? And at some points wouldn't you be healthy and pay less?

    Health is almost entirely a product of life choices. When you subsidize bad behavior, or worse, force everyone else to pay for bad behavior at the point of a gun, you get more poor choices.

    No matter your income, nearly everyone can eat well and stay fit. Those who cannot are such a tiny percentage of the population it is comic to suggest that charity cannot cover it (an older, obese woman just received over $400,000 in charity after being taunted on a school bus!)

    So this argument doesn't work either. Competition makes everything less expensive because it allows the pricing mechanism, which allocates resources, to work. Intervention makes everything more expensive for everyone, sick or healthy, old or poor.

    The step in the right direction isn't obamacare or romneycare. It's something that the US hasn't tried in health care in almost 100 years. It's the market.

    David in Liberty

  • Report this Comment On June 28, 2012, at 11:36 PM, skypilot2005 wrote:

    "---> Many of us have been killed or permanently injured protecting your freedoms. <----

    If that's true, why do I have less freedom now than I did before? Why does America have less liberty today than it has ever had?

    Hmmmm......

    David in Liberty"

    David,

    Reread my comment, slowly.

    Your question doesn’t make any sense.

    Sky

  • Report this Comment On June 28, 2012, at 11:48 PM, werich wrote:

    It seems to me an opportunity is being missed here that could be so simple. My wife and I are both pre-existing conditions persons having lived long enough to have lived? I smoked 28 years ago (enough to be denied coverage) and my wife has a mild heart condition controlled with medication (mitral valve prolapse).

    After being turned down for individual policies, we started a consulting business and immediately qualified for the same plan we were refused previously because we were now a group.

    My solution - make all insurers use the entire state they are doing business as the ONLY allowable group and rate accordingly, coupled with not being allowed to refuse policies for pre-existing conditions. The rating gets really messed up when they do individual policies compared to group ratings where they can spread the risk. Making the group large (state) will reduce the risk of an individual policy, and level the playing field with regard to rates - the individual would have rates available similar to what only a fortune 500 company had access to previously. There are too many games being played with regard to rates, groups and group size, and access to coverage - this would protect both the insurer and the insured and improve access without a mandate. Maybe more of the 40% not covered could afford coverage if rates were rational? Just rantings of an almost geezer....

  • Report this Comment On June 28, 2012, at 11:58 PM, wan2bretired wrote:

    I thought this was an investment site, not a political blog. Clearly, Morgan you are a progressive ... why not admit it, i.e. put a disclosure on all your articles. There are alot of things that people should due or own but don't by choice. Many of those decisions effect us all financially just like someone not buying health insurance. Should we make ever item a tax so that everthing that the goverment decides we should own we have to buy? Cigarettes, obesity, lack of exercise cost more to the health care system than the unisured, how much do we want the goverment to interfere in our lives? Utopia would be all of us healthy, wealthy and wise, but life is not utopia.

    I am a physician, and provide a lot of free care for which i am proud. Goverment has made providing health care more costly. Obamacare will increase the cost of providing care, on a per patient basis, while decreasing reimbursement. The cost of providing care has escalated (overhead) but reimbursements to date have been flat (over the last decade). In my practice and in the region the age in my specialty averages over 50. The baby boom peak is occuring over the next decade.

    More practices are going to physician assistants and nurser practionioners.

    Go ahead an celebrate obamacare, but when you need to see a phycisian in the future, good luck. The name of the plan, AHCA, sounds great, the features listed by Morgan are the only nice features. You listed them in about 7 lines, but the bill is 2500 pages. What lurks beneath is the issue, not the nice fluff listed by Morgan.

    Lets stick to all that is about investing.

  • Report this Comment On June 29, 2012, at 12:54 AM, The1MAGE wrote:

    This article explains exactly why a preexisting medical rule must be in place for insurance companies to function. Without it, people will simply jump in and out of insurance plans, only buying it when they need it, and dumping it when they don't.

    Sure we care about those people, but they should have had insurance before their problem came up.

    But instead of mandating that everyone has to own insurance, they could simply say that anyone who has had insurance within a certain amount of time bypasses the preexisting condition, as long as they did not dump the insurance without good reason.

    Of the "50 million" without insurance, many actually do not want it. Yes, most of those are dumb teenagers, but one of the things I like about this Country is the ability to be dumb. (Then the school of hard knocks comes and slaps you across the face.) And I do believe that number includes illegal aliens (yes, another debate,) they should not be included in these numbers.

    My wife has a preexisting condition, and she does feel a little stuck at her job as a result. (Good thing she likes what she does.) Without the insurance, her meds jump to over $1,000 a month.

    And I still oppose this legislation.

    Well much of it that is. There are some good aspects, (it's not a black and white issue here,) but I do believe the bad overshadows the good.

  • Report this Comment On June 29, 2012, at 12:56 AM, LookingthroughU wrote:

    Morgan, you have written some other interesting articles, but I have to say I am disappointed to find this one as a headliner on TMF. Great if this were a fundraising letter for Obama's reelection campaign, but that seems a bit off task for this site! It may be too soon to tell, but there will certainly be some winners and losers based on this legislation...that is what I come here to find.

    The ACA does little or nothing to address the real problems that plague our health care system, which is a real shame given how much time and energy went in to the project. I suppose once we reach the endgame of ACA and the 'new' system implodes, then we will be begging to have the single payer system that seems so wonderful to many of the commentators above.

    I also hope the nurse practitioner who some day does my prostatectomy will have paid close attention while watching the 'how to remove a prostate' video on YouTube. Or even better, all my Foolish investing will have paid off and I'll be able to afford to go outside the system and get my care alongside the politicians and other ruling elite.

    For now drink your Kool Aid fair believers, you had a big day today.

  • Report this Comment On June 29, 2012, at 12:56 AM, wtatm wrote:

    @TMFmorgan

    dj1962 mentioned "price controls". I think what (s)he may be talking about is the minimum loss ratio (MLR) requirements of the law. I was working for a health insurance client this past summer (I'm a health insurance actuary). In the ACA, there are requirements of MLRs of (I believe) 80% for individual health care plans and 85% for group health care plans. I believe that the 80% or 85% just refers to actual benefit payments to the insureds. If your product fails to make an 80% or 85% loss ratio, premiums will need to be refunded to the policyholders until your loss ratio comes into compliance.

    If I have these details right (and I will confess, I need to read / review the law as I haven't looked at it in a few months!) this leaves only 15-20% of premium for everything else. But... 15%... 20%... even 30% of premiums, depending on state... winds up in the legal system. This was one of the major failings of the ACA... it did not address expenses in general and tort reform in particular. Obviously, in doing the math, there is little... if anything... left over for company admin, claim adjudication expenses or profit. Additionally, the ACA adds an additional level of fairly significant regulation and reporting at the federal level on top of the existing regulation at the state level.

    Add all of this up, and there are going to be incredible pressures on health insurance companies to be able to avoid consistent losses in the health insurance product line. It's not a foregone conclusion that everyone will drop out, but I would expect over the next few years to see some companies throw in the towel, rather than sustain continuing losses... at least in some states.

    Jim

  • Report this Comment On June 29, 2012, at 12:59 AM, DonkeyJunk wrote:

    @wan2bretired

    Ignore this paragraph and you have a purely investment-oriented article:

    "The measuring of political wins and losses misses the point altogether. The winners here are the nearly 50 million Americans who don't have health insurance. They're the majority of personal bankruptcy cases linked to medical bills, and those who couldn't quit their job because they can't afford to lose employer-provided coverage."

    Note, however, that removing this paragraph does not change the investment argument.

    The Fool does a pretty good job of providing articles that support both sides of an argument from a financial standpoint. If this article does not support your confirmation bias, I'm sure you can find one somewhere on the site that does.

  • Report this Comment On June 29, 2012, at 1:09 AM, klk5439 wrote:

    Some issues are eternal, the line

    My solution - make all insurers use the entire state they are doing business as the ONLY allowable group and rate accordingly, coupled with not being allowed to refuse policies for pre-existing conditions.

    is pretty close, if I remember correctly, to the main strategy of the Clinton plan back in 1992-3. Reading articles about that time are very instructive, i.e making the bill 1200 pages long and acting as if they were the smart ones, (actually only a few people wrote the bill up), there was one scene where Democratic Senators who wanted to back the bill asked Hillary to give them the critical selling points, she said that was too difficult, and the Senators basically gave up. Republicans may have simplistic policies that lead to catastrophe, but they know if you can't articulate a few critcal points, a policy can't be sold(sort of like reasons for investing in a company).

  • Report this Comment On June 29, 2012, at 1:52 AM, hbofbyu wrote:

    For the sake of your health, maybe it is best to take away control from those who are trained in medicine. Politicians, bureaucrats, insurance companies, lawyers and billion dollar health care conglomerates. These will sooth whatever ails you. Not.

    A free market exchange directly between the doctor and the patient is the most market efficient solution and one that I have used many times in the past. No health insurance for me while I was unemployed. I got great care by paying cash directly to the doctor for services at more than half price while not contributing a dime to the $950,000 salary of an insurance or billing company vice president.

    If the government can tell you what to buy they may soon tell you what to eat, drink and smoke (Look for the Asparagus Mandate Act of 2016).

    Our doctors, hospitals, MRI machines, heart surgeons, nurses - all are a finite resource. How does scrambling up every peripheral industry involved somehow create more health care for all? It doesn't. There will be less for some and more for others.

    This bill does not change the resources (it does not add doctors or MRI machines or amazing new drugs), it only changes insurance costs and raises taxes. There will be net winners and net losers and the net winners will all be voting Democrat this fall. (Their vote purchased courtesy of Nancy Pelosi). "There's nothing wrong with spreading the wealth around."

    And so we continue to put incentives in place for less and less people to pull the cart as more and more people jump inside for the free ride. Pretty soon the cart stops moving. But according to our president you must always be willing to add more people to the cart because "...it's the right thing to do."

  • Report this Comment On June 29, 2012, at 1:53 AM, Hitchhiker042 wrote:

    Anyone know anything about Uruguay? I've heard it has a relatively stable government...

  • Report this Comment On June 29, 2012, at 1:56 AM, hskinnemoen wrote:

    If you're saying "I don't want to pay for other people's health care" without also saying "I'm prepared to die if I get seriously sick and can't afford treatment", you're a hypocrite.

  • Report this Comment On June 29, 2012, at 3:21 AM, Zombie111 wrote:

    In reply to Viking 74: I got the statistic re how much of your taxes goes to the Pentagon from an article from TMF, where it was vigorously debated.

    In reply to TMF Morgan, my point re my relative's operation being free to him was that it was paid for by his and everyone's taxes. Paying taxes or paying an insurance company, we are all paying one way or another. Just with the recent experiences with insurance companies trying to weasel out of their obligations whenever possible (in my country after a natural disaster), I know who I will pay my money to.

  • Report this Comment On June 29, 2012, at 4:39 AM, Spw225 wrote:

    This will be the largest tax increase in history. No one lists the tax increases. All government programs become inefficient and bloated. This will be no different. In England the health care system works worst for the elderly and chronically Ill as health care is rationed. If you need an operation ex hip replacement in England, you cant get it when you need it. They make you suffer with delay after delay. The same thing will happen here. Standards and innovation will suffer as a result of government control of one sixth of the economy. This decision by Roberts was cowardly. It is always hardest to protect individual liberties, than to side with government.

  • Report this Comment On June 29, 2012, at 5:18 AM, Duke02 wrote:

    What do you think people said when SSI ,medacare ,unemployment insurence came into play ? Same stuff ,just reheated ...

  • Report this Comment On June 29, 2012, at 6:30 AM, deadontarget wrote:

    I think this article is leaving out most of what is in Obamacare. I didn't know the fool had biased articles....is there no where to hide from the left media

  • Report this Comment On June 29, 2012, at 6:39 AM, skypilot2005 wrote:

    On June 29, 2012, at 4:39 AM, Spw225 wrote

    “This will be the largest tax increase in history.”

    The Obama administration said it wasn’t a tax up until they defended it in court. This destroys their credibility.

    “All government programs become inefficient and bloated. This will be no different. In England the health care system works worst for the elderly and chronically Ill as health care is rationed. If you need an operation ex hip replacement in England, you cant get it when you need it. They make you suffer with delay after delay. The same thing will happen here.”

    This is true. The defenders of Obama Care need to explain how they are going to increase the number of Doctors we have under our new Health Care system. Otherwise, it is a simple economic fact. Re. Supply and Demand.

    “Standards and innovation will suffer as a result of government control of one sixth of the economy.” Yup. This cannot be credibly challenged.

    “This decision by Roberts was cowardly.”

    I don’t know. At first I had similar feelings. But, I’ve slept on it.

    I think his position may be that if we don’t like what The President and Congress did, we can change this by voting them out of office in November.

    That position has merit by being an example of NOT legislating from “The Bench”.

    BTW, I oppose Obama Care. I will be voting against a U. S. Senator from my State that voted for it primarily because of their support for Obama Care.

    It just does not "work" without increasing Doctors and limiting lawsuits, first.

    Sky

  • Report this Comment On June 29, 2012, at 9:10 AM, BarneyRubbel wrote:

    Incredible, people don't understand that WE ARE PAYING NOW for the uninsured! Why do you think healthcare costs so much. We should get the care we are paying for. The hospitals pass the costs on to ALL OF US, NOW. This improves coverage and care, I'm glad its official.

  • Report this Comment On June 29, 2012, at 9:43 AM, NEMnyWtch wrote:

    <<The US government spends more on health care per capita than almost all European countries -- and we only insure our elderly and poor, while they insure everyone>>

    So, if the US government is doing such a great job with the tax money already being provided, penalizing folks to insure everyone...er, um, excuse me, TAXING them more, is a good idea Morgan?

    Your statement seems to suggest the idea that we should be able to insure everyone with the money already provided.

    Are all of TMF writers drinking the KoolAid??

  • Report this Comment On June 29, 2012, at 9:54 AM, budgetace wrote:

    The results of this legislation and court ruling is entirely predictable. As happened in europe, more and more doctors will opt to enter into "private practice" and will not treat medicare, medicade and many insured patients. Those with money will continue to receive excellent medical care and the remainder will be forced to see poorly trained imported doctors with, in many cases, limited english language capabilities who will be brought in to cover the shortfall.The wait for medical treatment is likely to increase dramatically and even denied to some patients based on age and cost. As a senior citizen I and very concerned about the future of health care in the U.S.

  • Report this Comment On June 29, 2012, at 9:56 AM, TMFMorgan wrote:

    <<So, if the US government is doing such a great job with the tax money already being provided>>

    Where did I say that?

  • Report this Comment On June 29, 2012, at 10:04 AM, Viking70 wrote:

    @ir0b0t,

    As a former member of the military, reconstructon contractor, and also as a person who can read, I can tell you that there is no way we have been spending 54% of the taxes we take in on the Pentagon. We might be spending 54% executing the wars in Iraq and Afghanistan, but that is not a military expenditure it is a POLITICAL expenditure. Even then the number is incorrect as a great amount of the funds spent in Iraq and Afghanistan are spent on RECONSTRUCTION, which is largely executed by military organizations like AFCESA, AFCEE, and CoE. That money doesn't go to the Pentagon, it goes to US and local contractors and to a great extent bribes for Iraqi and Afghani government officials. And before you think I am pulling that out of my butt, spend three years working in Afghanistan doing reconstruction like I did and get back to me when you get done.

    The percent actually spent on the "Pentagon" is closer to 5 - 10%.

  • Report this Comment On June 29, 2012, at 10:51 AM, BellemonteCo wrote:

    I'm much more interested in how this effects me as an investor. Other than the obvious---being careful around the insurance stocks--- you're not really giving me any information that I can use as an investor.

  • Report this Comment On June 29, 2012, at 10:54 AM, hbofbyu wrote:

    What is wrong with trading a little freedom so you can be covered with health insurance? Nothing, if it is your own decision; everything, if it is not.

  • Report this Comment On June 29, 2012, at 11:10 AM, garyjyager wrote:

    Health Care Reform. Love it or hate it, we can be thankful some exceptionally stupid bits have been removed.

    1099 Reporting Requirements. This was the major source of funding for health care reform. Except when everybody had chance to read the law; businesses said it would be a paperwork nightmare, the IRS said the cost of collecting the revenue was more than the revenue that could be collected, congress said “oops”. Pres said “oops” and repealed that part last year.

    Health Plan ID. Assign every health plan a unique ID to make it easier for processing claims and stuff. Brilliant. Except that the timeline to implement it was hilariously short. Calling it Impossible really didn’t do the ridiculousness of the timeline specified in the law justice. Luckily NCVHS recommended that the “Compliance Date “ in the law, the date when every doctor and insurer had to use it on all insurance transactions, should be redefined to mean the date when insurers could begin to apply for one. Even so DHHS still can’t meet that redefined date to begin assigning those IDs.

    American National Standards Institute pointed out that the health care reform law was worded in such a way that it stated that all the standardized electronic transactions called for in the HIPAA health reform law to make it easier and less costly for a doctor work with many insurers could no longer be used. New transaction formats had to be developed. These new transactions would function the same, provide the same benefit and would cost the industry and government collectively about a billion. Yep, cost = $1 billion, benefit = $0. This part of the law has also been amended.

  • Report this Comment On June 29, 2012, at 11:15 AM, Darwood11 wrote:

    Interesting article and interesting comments.

    I too am concerned just how this will work. The law doesn't seem to address costs,

    I see a few problems. First, the federal government has been lousy at providing long term cost estimates. Medicaid was supposed to be a small program which was touted in 1965 or so as something which would "never amount to much." in terms of costs.

    If Medicaid expands that will probably cost the states over time. I know, the law currently has specific provisions for limiting the costs to the states, but that could change.

    Sure winners seem to the the hospitals, etc, who currently provide some free medical care. If everyone is insured, that should increase the profitability.

    Bottom line; health care and health insurance is a mess in this country. Costs are out of control. Insuring everyone means those who currently avoid health care will now avail themselves to it. Some in the medical profession say this will ultimately lower costs, because these reluctant people will now rely on a primary care physician. In other words, by doing so these people will because of government decree live magically healthier lives! Just like the rest of us?

  • Report this Comment On June 29, 2012, at 11:16 AM, Ozzieka wrote:

    I was wondering if anybody know if there was a rider with the Health Care Bill that had a 3.8% sales tax on selling a home?

  • Report this Comment On June 29, 2012, at 11:17 AM, zrxman60 wrote:

    I don't think it's wise for the President to add debt to the poor and middle class by enacting this "health care" plan which will actually make my health care worse and more expensive. Now my doctor won't be able to spend as much time with my care because I'll be standing in line behind 25 illegal immigrants who are going in for a first-time physical or care for their 15 babies.

  • Report this Comment On June 29, 2012, at 11:17 AM, ToyotaOkieC wrote:

    Aside from being afraid that this new tax will consume most of my discretionary income, I am also afraid of what the new, massive database will lead to. I have no health issues that require meds. I don't want to have their drugs foisted on me. I don't want their flu shots. Right now, at work, they are using "carrots" to try to rope everyone into their so-called "preventive" care screenings. I figure it's just fishing for new suckers to take their worse-than-useless drugs. What recourse do I have when they switch from "carrots" to "sticks"? I have a relative who is a civilian employee at a military base. They pursue like hounds the people like my relative, to try to get them to take their annual flu shots. Even when these avoiders do the paperwork to "opt out", that can be overridden on a whim...or as a mistake...leading to unwanted "treatments". My relative felt "violated" when forced to submit to the most recent flu shot.

    I agree with a previous poster who pointed out that the USDA's widely-publicized dietary guidelines (a/k/a the "Food Pyramid") have led to the current obesity epidemic, along with its related diseases. Since I have been doing my own dietary research for the last 10 years, and have been following alternative guidelines, I have been able to avoid the usual triggers that make people go to the doctor frequently (pain, fatique, weak bones, allergies, fungus, high cholesterol, high blood sugar). If the feds have their way, my alternative method will probably become impossible to continue. That's what I fear the most.

    ON THE OTHER HAND, I cherish a weak hope that the common medical advice will lead to less unnecessary screenings and "treatments". I have noticed lately that we are being told to wait longer periods between certain screenings. Some treatments are being called out as being more destructive to wellness than they used to be. Maybe they will back off from trying to turn healthy people into patients if they get their pound of flesh via this new tax. Yeah, I'm sure that'll happen!

  • Report this Comment On June 29, 2012, at 11:17 AM, mariead wrote:

    Not sure what everyone is gone to do more jobs will be lost. Small buisness will not make it so get ready another recession if not worse than that. Yes we need something but not this, I am disable and yes I buy meds every month and have been told I cant get health care but the last thing we need is the goverment in our life anymore than they are. Please think do we really need another tax? Next the goverment will tell us where to take our next xxxx. I know I dont want that and I am sure if you think of it as a whole it isnt what you want either just the first thing offered to us.

  • Report this Comment On June 29, 2012, at 11:22 AM, maiday2000 wrote:

    hbofbyu has more understanding of this issue than most of the posters (Mr. Housel included) on this forum combined.

    If you want solutions that actually might deliver better health CARE (not health insurance) then read his posts.

  • Report this Comment On June 29, 2012, at 11:22 AM, tfwg wrote:

    Why doesn't this article mention that 200,000 SMALL BUSINESSES with 50 or more employees will not be required to purchase healthcare or pay the new tax. Or how about these new taxes:

    No. 1. The Individual Mandate Excise Tax. Starting in 2014, anyone not buying “qualifying” health insurance must pay an income tax surtax. It goes up each year until 2016 and beyond when a couple would pay a tax of the higher or $1,360 or 2.5% of adjusted gross income.

    No. 2. The Over-The-Counter Drugs Trap. Since Jan. 1, 2011, employees with health savings accounts, flexible spending accounts or health reimbursement accounts have no longer been able to use pre-tax funds stashed in these accounts to buy over-the-counter medicines for allergy relief and the like without a doctor’s prescription (there’s an exception for insulin).

    No. 3. The Healthcare Flexible Spending Account Cap. Starting Jan. 1, 2013, employees will face a $2,500 cap on the amount of pre-tax salary deferrals they can make into a healthcare flexible spending account. There is no cap under current law. In light of the new cap, employee benefits groups are lobbying for Congress to modify the use-it-or-lose-it rule that means employees forfeit unused funds in their accounts at the end of the plan year.

    No. 4. The Medical Itemized Deduction Hurdle. Starting Jan. 1, 2013, taxpayers who face high medical expenses will only be allowed a deduction for expenses to the extent they exceed 10% of adjusted gross income, up from 7.5% now. Taxpayers 65 and older can still use the old 7.5% threshold through 2016. For how to score the medical expense deduction before 2013, click here.

    No. 5. The Health Savings Account Withdrawal Penalty. Since Jan. 1, 2011, taxpayers who withdraw money from health savings accounts for non-medical expenses before age 65 face a 20% penalty, up from 10% before.

    No. 6. The Indoor Tanning Services Tax. Since July 1, 2010, folks using indoor tanning salons face a new 10% excise tax. This one hasn’t been bringing in as much revenue as anticipated.

    No. 7. The Cadillac Health Insurance Plan Tax. Starting in 2018, there will be a new 40% excise tax on taxpayers who are covered by comprehensive health insurance plans.

    http://www.forbes.com/sites/ashleaebeling/2012/06/28/obamaca...

  • Report this Comment On June 29, 2012, at 11:23 AM, JayLowell2 wrote:

    At what gross income figure does the Heathcare Tax kick in for the uninsured.Someone was talking about 30000 for a married couple, is this true?

  • Report this Comment On June 29, 2012, at 11:24 AM, libertysdead wrote:

    What I find most shocking on this board is the lack of skepticism about big government's ability to operate a lemonade stand much less 1/7th of our GDP. Clearly something needs to be done to provide health insurance to those in need but let the market provide a solution by creating competition amoung insurance providers with government oversight. knock down the state barriers and toughen tort laws and see what happens. Wake up people we cant afford to give the government this much control over our money and our health.

  • Report this Comment On June 29, 2012, at 11:25 AM, Charliechap1980 wrote:

    Can I just say that coming from England where we have the NHS, where service's are free at the point of delivery.

    I cant believe anyone would vote against better medical care, especially the poor. Its so sad that America is run by companies, greed and immorality, it is even if you don't think so. Nation of the free, Nation of the hypnotised maybe.

    Ps im not saying we are perfect over here, far from it, but you have to look after the poorest in society, and that will give you the moral high ground. No wonder other countries in the world look at the US and think your hypocrites.

  • Report this Comment On June 29, 2012, at 11:27 AM, garyjyager wrote:

    Just to be clear that 3.8% tax is a tax on profits over the capital gains threshold. It isn't a sales tax, as it isn't based on the sale/purchase price.

  • Report this Comment On June 29, 2012, at 11:28 AM, Pandc5sN wrote:

    Aknowledging that there is plenty to be aware and beware of in "ObamaCare" (especially the end effects of medical care rationing that is going to have massive impacts on us all and especially the baby boomers)...the primary impacts on the economy that are immediately evident are all negative. The most immediate concerns are:

    1) The effect on job creation and investments resulting from Dividend Income going from a 15% tax to a 43.4%.

    2) The effect of Capital Gains Tax going from

    15% to 23.8% on retirees, pension funds and 401K-IRA accounts just as those accounts are becoming taxable due to retirees withdrawing what is left of their retirement funds.

    3) The total effect of redistribution of wealth in the U.S. from those who have created wealth through hard work, sacrifice and planning...to those who have made a lifetime fo bad decisions resulting in dependancy.

  • Report this Comment On June 29, 2012, at 11:32 AM, getUNoutofUS wrote:

    Some writers seem to think government HC (Medicare) is free. Current workers pay medicare tax in their payroll tax. That and the small payment by participants (granny) as well does not cover the total cost of medicare. That is why Medicare will be bankrupt in less than ten years without raising the Medicare payroll tax. To make things worse Obama and company have "given" a 2 year reduction of this payroll tax that will exacerbate the shortfall and bring bankruptcy quicker than previously calculated and add to the more than $15 trillion of national debt. They just keep borrowing and passing on that debt to my kids and grandkids. 20somethings need to wake up and realize Obama has sold their futures down the river. Wake up America!

  • Report this Comment On June 29, 2012, at 11:33 AM, St3jace wrote:

    @Plinkon Just because someone doesn't want to be forced by the government to pay for healthcare for everyone doesn't make them inherently selfish. Your argument doesn't take into account what it means to delegate a government to have the ability to use force in order to get what it wants. "selfish" is subjective according to what you think that definition consists of in someones character and actions.

    There are other ways that markets could assimilate healthcare costs, but the constant interference of a government that has no idea what its doing continues to stockpile the problems we face through constant deficit spending. You argue against "selfishness" as if the fact that every dollar is borrowed into existence, and the monopoly use of force the government has has nothing to do with this healthcare plan... What say you?

  • Report this Comment On June 29, 2012, at 11:34 AM, nmartell22 wrote:

    I think this MarketSnacks.com article perfectly explains what the court ruling meant for the stock market - short, clear and interesting:

    http://marketsnacks.com/2012/06/28/european-growth-fund-news...

  • Report this Comment On June 29, 2012, at 11:36 AM, TMFMorgan wrote:

    <<Just because someone doesn't want to be forced by the government to pay for healthcare for everyone doesn't make them inherently selfish.>>

    I protest. It's selfish because that person pushes the cost of their inevitable medical care onto those who pay for insurance. The mandate forces personal responsibility.

  • Report this Comment On June 29, 2012, at 11:37 AM, getUNoutofUS wrote:

    Explain to me how we cover more people with Government insurance and it somehow costs less Wake Up America!

  • Report this Comment On June 29, 2012, at 11:39 AM, fatearthworm wrote:

    Mark my words ...

    Our government must kick the insurance companies out of health care.....sooner if not later... These leeches exist for one reason - profits..

    This has no place in health care.

    The conservative propaganda machine knows this.

    Progressives must become unified and united to stop this (the tea baggers)..

    If not, I dread to consider the shape of our nation if the conservative are allowed to "run amuck"..

  • Report this Comment On June 29, 2012, at 11:44 AM, St3jace wrote:

    @TMFMorgan Personal responsibility? how is it responsible to pay for other people's costs, while struggling to pay for your own life, on top of a state bankruptcy for example california... It's not congruent. Let's be real, it's not tackling fundamental problems with our economic state of affairs and is more patchwork. So sure, we can all argue the good and bad of a patchup job, and fail to look at fundamentals. And you can draw conclusions about personal responsibility, ethics, and mandates if you like... doesn't change fundamental operations of forcing people to do things while simultaneously ignoring its own background of failure. I think that's called something like cognitive dissonance.

  • Report this Comment On June 29, 2012, at 11:45 AM, PoorerThanU wrote:

    @Plinkon

    You must be a communist. From each according to his ability; to each according to his need. Sound familiar to you? (The whole problem with communism is who decides what the abilities and needs are?)

    Free markets and personal liberty is about making decisions and reaping consequences. Accidents happen and life is not fair. Explain to me why I should have to pay for your accidents and bad habits. Choosing to be selfish is a personal choice, and someone will surely reap the consequences of that choice. Confiscating by force (taxes) my labor is immoral and illegal for everyone except the state. Period.

  • Report this Comment On June 29, 2012, at 11:47 AM, TMFMorgan wrote:

    <<how is it responsible to pay for other people's costs>>

    Those who pay for insurance and implicitly cover the cost of free-riders have been asking that for years.

  • Report this Comment On June 29, 2012, at 11:50 AM, truth4u wrote:

    Morgan, you FOOLISH Fool: Are you sure you can still make money by telling truth? Your analysis of the new Health Care Law was clear and succinct. What a nice job you did, with a tough subject, in a short amount of space.

    This piece is one of the fairest viewpoints ever expressed by THE FOOLS- - in my opinion.

    I'd trust you with my Money - - if, I had any.

    don (subscriber)

  • Report this Comment On June 29, 2012, at 11:52 AM, mbeach89 wrote:

    I'm not in favor of the government FORCING me to buy ANYTHING! Wouldn't it have been easier to just put everyone on Medicare and up the Medicare tax? Then you could choose whether or not to buy the supplemental insurance to pick up the 20% that Medicare itself doesn't cover? Increasing the deductible would also save $$$ and encourage people to develop healthier lifestyle.

  • Report this Comment On June 29, 2012, at 11:54 AM, dtor wrote:

    Any/All,

    "I'm healthy, why should I pay?" is specious.

    Personal example: I was in "great" health. Regular checkups. Low BMI, cholestrol, no family history of anything but longer-than-normal lifespans.

    Regular racquetball player. Local tournament, finals, won first game, score 11-3 in the seond. Experienced a very bad feeling. Forfeited, the game and the match and drove myself to the hospital. Survival rate < 8% for that type of heart attack.

    Obviously I'm still looking at the grass from the green side. On the other hand, if my wife and I had not been cross-insured (very costly), we would have been bankrupt and both of us wishing I hadn't made it.

    The "I'm healthy..." is specious because there is no known method or methods to predict continued good health - ignoring damage from external events.

  • Report this Comment On June 29, 2012, at 11:56 AM, TMFMorgan wrote:

    <<Wouldn't it have been easier to just put everyone on Medicare and up the Medicare tax? Then you could choose whether or not to buy the supplemental insurance to pick up the 20% that Medicare itself doesn't cover?>>

    To add: Most don't realize that 90% of French citizens have supplementary private insurance that covers procedures and treatment the universal system doesn't.

  • Report this Comment On June 29, 2012, at 11:58 AM, APost100 wrote:

    First, let me say that I sincerely believe that both political parties would like more than anything for all Americans to have access to adequate health care. It is how to best accomplish this that is in debate.

    I think there are two primary questions that the bill does not address.

    First, we have to ask what is is about our health care system that is “Broken”. I think we can all agree that runaway cost is the answer to that one. Now that we all agree on that, we have to ask the hard question. Which method do we use to “Fix” this problem? We either cover the ever increasing cost, or we reduce the cost. This bill is all about covering the cost, and what little there is that addresses reducing the cost seems to be more theory than a certainty borne from past experience.

    The plan is to cover the cost by attemping (and I think we honestly have to say attempting until this thing runs for 10 years) to have everyone covered. As insurance companies are for-profit businesses, the costs we are now covering via insurance will cost more. Even worse, rather than just add insurance company profit on top of what is now uncovered care, we are going to add the cost of getting more federal bureaucracy involved. The track record of Government programs coming in on budget is not a good one.

    There are parts of the bill that I believe in; coverage for people with pre-existing conditions, no lifetime caps (5 Million doesn’t buy what it used to), and we as a people are indeed our brothers keepers and just have to man up and help out.

    As it stands, I believe this program has more opportunity to greatly increase the real cost of health care, and that is anything but reform.

  • Report this Comment On June 29, 2012, at 12:01 PM, foolhardy7 wrote:

    Unfortunately, the "Tweet heard round the world," as quoted above, is inaccurate. One need read no further than the Court's syllabus to see that the court did Not uphold the "Mandate," notwithstanding that certain political spinmasters prefer to use that word. The Court clearly held that Congress Cannot compel people to do something that doesn't relate to activity they already are doing. What it Can do, however, and what was upheld here, is that Congress can Tax people who do Not have health coverage -- essentially because of the burden they are putting on the system. There is no Mandate to buy. There is a Tax if you don't. That is what was upheld. The practical effect may be the same, but the constitutional analysis is different.

  • Report this Comment On June 29, 2012, at 12:06 PM, actuary99 wrote:

    @wtatm

    Like you said, it's 80% minimum MLR for individual and 85% for group.

    Important to note: The calculation to meet the loss ratio requirements removes taxes and fees from the denominator, and added quality improvement expenses into the numerator. Also the NAIC has come up with a way to have the minimum MLR credibility-adjusted over a few years. I have an excellent .ppt presentation on the MLR requirements, let me know if you're interested, I may have to edit it a bit because a portion may be proprietary.

    "If I have these details right (and I will confess, I need to read / review the law as I haven't looked at it in a few months!) this leaves only 15-20% of premium for everything else. But... 15%... 20%... even 30% of premiums, depending on state... winds up in the legal system."

    I would think legal fees due to malpractice as well as malpractice services would be built in to a provider's fee. Therefore they would fall under medical costs and not eat away at the maximum 15% (20 for individual) gross underwriting margin.

    Am I missing something?

  • Report this Comment On June 29, 2012, at 12:07 PM, actuary99 wrote:

    *"malpractice services" should read "malpractice insurance"

  • Report this Comment On June 29, 2012, at 12:08 PM, whereaminow wrote:

    @Sky,

    Sorry if I misunderstood. It was late.

    David in Liberty

  • Report this Comment On June 29, 2012, at 12:10 PM, LindaLB wrote:

    Thank you for this fair and accurate description of the law. As usual, the Motley Fool has proven itself to be a source that people can rely on. Thanks!

  • Report this Comment On June 29, 2012, at 12:28 PM, JayLowell2 wrote:

    I became ill in 2010,I had to leave my job of thirty five years.I couldn't collect on Unemployment or Disability Insurance.I have been out of work for two years living a very frugal life style. I cannot afford health insurance as my income is below 15000 a year and my partners income is similar.Im am recovering but finding a job at 60 is a pipe dream.Im not asking for help Im asking for Freedom of choice.How does an added tax benefit me the so called Poor?

  • Report this Comment On June 29, 2012, at 12:31 PM, truth4u wrote:

    Here's the deal, Pea Brains on both the Right and the Left: Obama Care was/is, not perfect. It was rushed through too fast; and it does contain some real challenges. I am Chilled, when the Cost of the Program is discussed. Don't think anyone really knows . . . Yet, we had to get something in place; and apparently, this is the best that we could do, given the current divisive climate in Washington.

    Let's HOPE, that OBAMA CARE, is repealed, so that we can GET IT RIGHT! The Nation desperately needs a Singer-Payer, National Health Care Plan.

    We are BROKE! and can no longer play Politics with this Need. It's NOT Rocket Science! If, nothing else; let's put everyone under Medicare. Seniors Love It! and the Infrastructure is already in

    place. Estimates are that the Country would save $400 Billion Dollars in the process. If that is true, why hasn't it happened? Simple Answer: The Rich, Neo-Conservatives do not want to strip away profit margins of 30 - 33%, from the Nation's Predator Health Insurance Companies. They would rather see 50 Million people go without Health Insurance - - than give up a dime!

    With reference to why one might hope Obama Care might be repealed? FIRST, it would allow the Country to re-open discussions on an Affordable National Health Care Plan. The Mood of the Country is changing, as the Economic Noose around the Necks of everyone but the top 10%, is tightening; and, the Middle Class is being hollowed out.

    SECONDLY, George Will, the noted Columnist, has suggested that the Country needs to address a question that Precedes discussion on any Health Care Plan: DO THE PEOPLE OF THE UNITED STATES BELIEVE THAT HEALTH CARE IS A MORAL IMPERATIVE, FOR ALL AMERICANS? Obtain a Consensus on that, and then debate Models. (George, you are a genius; why didn't I think of that?)

    One has to wonder, with so many critical issues confronting a new President and Congress; whether Repeal, and the subsequent, "Can of Worms," that could be opened, might be problematic; for, one of the two Parties. Sometimes the Devil you know, is better than the Devil you don't know.

    Bottom line: Do Political Candidates really want to piss of, Minorities, Women, the Un-and-Under Insured,right before an crucial Election? Further, the Middle Class has been decimated, and hollowed out. Who wants to address those people at an Open Forum? The Worm - - it is-a-turning.

    Let's wait and see which Party has a, "Death Wish," Who knows, some may chose to win the Battle, and Lose the War.

    Happy Hunting - - and with Good Will.

    doktor

  • Report this Comment On June 29, 2012, at 12:42 PM, Firsk wrote:

    Other industrial countries represent real world laboratories that help us see what works and what doesn't. Polling consistently shows the French, the Germans, the Swedes, Japanese, and all other Industrialized countries are quite happy with their health care systems. Do anyone here seriously think ANY other first world country would trade their health care system for ours? These countries pay much less per capita- from about half to a third- for care, and they have better outcomes, by any metric. Why are we paying two to three times as much for worse results? Many here want to count as "waste" only what is due to government inefficiencies- but to the economy, waste is waste, and our private insurance health care model is a wasteful drain on the American economy. And health care is not just a personal responsibility issue- public health is, well, PUBLIC- the person with untreated drug resistant TB coughs on rich and poor, insured and uninsured.

    We pay much more, for worse outcomes, with our market based system. The private health insurance industry must spend huge sums marketing their products, and then even more figuring out how to deny care in order to maximize shareholder profits, and then more to confound caregivers with forms and bureaucracy in order to delay payments. What we have is the most wasteful health care system in the first world. Government run or much more highly regulated systems in other countries operate far more efficiently. Health care is an area where unregulated markets just don't work, for lots of good reasons- asymmetry of information being a very big one. Even Friedrich Hayek, whose suspicion of the state was visceral, had this to say in “The Road to Serfdom:”

    “Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance — where, in short, we deal with genuinely insurable risks — the case for the state’s helping to organize a comprehensive system of social insurance is very strong.”

    All countries ration health care. Some do it by a public process accountable to the people, we do it by who can afford to pay- or who can game the system to their benefit. Anyone who thinks that health care is not rationed by the private health insurance industry has either never had to pay for insurance themselves or has never run afoul of their insurance companies' bureaucracy. I'll take my chances with government bureaucrats any day. At least they work for me. Read the testimony former Cigna senior executive Wendell Potter gave before congress, or any of his interviews.

    And our system is not just expensive up front, it has huge hidden costs. I am an independent entrepreneur, one who started a company that is responsible for manufacturing highly specialized electronic instrumentation in the US- a real job creator, not just someone shuffling dollars in a zero sum game. I can state without reservation that the biggest impediment to entrepreneurship (particularly for freelance engineers, designers, and others in the new economy who operate essentially solo or in very small groups) is the lack of access to affordable health care for individuals or small businesses. This is particularly true if you have a family member with any medical problems, or are over 50. And most start-ups are self funded and founded my the middle aged. How much does our economy lose when new businesses never get started because the entrepreneurs can't get health insurance? Without the market clout of a big organization, they must pay much more for worse coverage, if they can get it at all. The private health insurance market does not work.

    Do we really think we can't do at least as well as Germany, or Italy, or France, in delivering and paying for health care? If we had a government system even just as efficient as any of these countries, the savings to our economy would be staggering, AND we would have better care. Is Obamacare/ Romneycare/ ACA a step in the right direction? Maybe. But it's important to realize that this law was, in all important structural features, designed by the Heritage Foundation and until recently was being promoted by Republicans as the "private enterprise" solution to health care. But when enacted by the other team, the identical policy becomes "socialism" and "government takeover". The levelly of cynical political posturing in this debate is stunning, but not surprising.

  • Report this Comment On June 29, 2012, at 1:11 PM, Jocim wrote:

    Those folk who think that if Obama care is repealed the Republicans will get it right and off their collective minds. We had 8 years of President Bush and nothing was done. These are some of the facts no one seems to mention:

    The USA is number 43 when it comes to infant mortality and the same for women dying in child birth. We are competing with Albania in longevity. We spend about 20 % of our GDP on health care, the British spend about 5% and the Canadians spend about 11%. They are in the top 7 in longevity and infant mortality. The problem with our system is that there is a massive propaganda machine trying to hide the fact that for many of us the health services are worse than the health services in the third world.

  • Report this Comment On June 29, 2012, at 1:14 PM, 1quality1 wrote:

    I still don't get it. The individual mandate is necessary to get the money to fund the ACA, but so far the reporting says that since the individual mandate was upheld as a tax then the ACA will go forward. That's the part that I don't get, how to pay. As the Washington state example shows, people flee high premiums since they can just sign on any time and get coverage. Well, what's the difference? The individual mandate, I mean TAX, is only $95/year for 2014 and goes up to $695/year in 2016 and thereafter is indexed to the cost of living. Oh boy, why buy insurance from strapped and failing insurance companies at the current costs of thousands per year, if you can just pay the fine, er I mean TAX? Unless everybody pays appropriately (same as us working dummies) for the cost of insurance, then the insurance companies will just stop offering coverage, nationwide, just like in Washington state. Then what?

  • Report this Comment On June 29, 2012, at 1:19 PM, truth4u wrote:

    The Big Question: Why should I have to pay?

    Because BO, said so! Get over it! JUST KIDDING!!!

    Folks, my Kids all went to Private Schools, why should I have to pay for public schools? I have my own Security Force, of sorts - - why do I have to pay the salaries of Local Police, who are fat and lazy, and sit around in their cars all day eating donuts?

    And Road Repairs? I don't drive much; but do have a Driver and I Fly most everywhere.

    You tax my cigs and cigars, and now you want to tax my soda? For what - - the sake of improved Health?

    Get My Drift? If one believes in an organized, and civilized Society, there must be a balance between

    selfishness, and the Public Good. The Rich simply cannot be permitted to take it all! And, if one does the Research, some of those huge gains have been made by destroying people's lives.

    To Wit: Buffet has called the Exotic, but Fraudulent Investment Schemes (like the Sub-Prime Loans, and their subsequent packaging into Toxic Assets, and sold all over the World; along with things like, CDS, and, so many others), - - "Financial Weapons of Mass Destruction."

    The Count: Ten Trillion Dollars was stolen from the Moms, Pops, and the Grand parents who trusted the Investment Banks to exercise some degree of Fiduciary Responsibility in the investment of their life savings, retirement and college funds, and more. Instead, they were victimized and lost EVERYTHING; their jobs, homes, cars, retirement plans, and money for the Kid's College.

    The Philosopher Hobbs, has said, that Man in a State of Nature (no laws, no rules, no organized society - - is in a State of War!) Is that what the Neo-Conservatives have in mind about limited Government - - or, even no Government Controls, Rules or Regulations? If that is the goal, one must consider the weight of numbers if Class Warfare ever reaches that point. But, not to worry; cooler heads will prevail. Yet, know this; the Kids are going to eat; either at my place . . or your place . . .

    Be fair and equitable in promoting the Public Good. Let's all work together to establish an Equilibrium between the Selfish Pursuit of Profits; and, what is in the best interest of the Public Good, for all of Society. Then everyone will have an equal opportunity to prosper.

  • Report this Comment On June 29, 2012, at 1:20 PM, ericandmisti wrote:

    I don't think anyone disagrees that having insurance is nice. What this law didn't do is control costs. Everything having to do with medical treatment in the US is ridiculously expensive. Getting the government involved will only make it worse. What should be done is eliminating red tape. Allow policies to be sold across state lines. Set up a standard insurance form that all companies must use for medical providers to fill out. Tort reform. Doctors spend a huge amount of their pay on malpractice insurance and order up lots of extra tests just to protect themselves from lawsuits. Part of the reason care is so expensive here is because of government involvement and insurance. There is no price competition. No one cares how much their treatment costs because they aren't paying for it. Whether you go to doctor A and have a $10K operation or go to doctor B and it costs $25K the amount you pay doesn't change (most of us would max out our copay either way). When you go out to buy a car (or any other expensive item) one of the first things you check is what will it cost. When you go to the hospital you don't even ask the price. I never ask what it will cost when I or someone in my family goes to the doctor. (When I go to the dentist where I do pay half of the bill for many things I do ask). The law that has been passed will only reduce the quality of care and dramatically increase taxes for the 50% who actually do pay taxes. It doesn't control costs.

    I have insurance. If the company I work for was not paying the majority of the cost I would buy a catastrophic policy with a $10K threshold and just pay for whatever other care I needed. Catastrophic policies are not that expensive, but are not allowed under the new plan. If someone can't come up with a couple thousand dollars to pay for treatment not covered by a catastrophic policy how will they come up with $15K to pay for insurance? The answer is they won't. The descent of the US into a Greek type default will be dramatically accelerated by this law.

    I can hope that the law will be repealed and replaced by something reasonable, but I am too realistic to expect it to actually happen. The reality is that once an entitlement program is in place it isn't going away. This new multi-trillion dollar one won't be any different.

    Eric

  • Report this Comment On June 29, 2012, at 1:21 PM, JohnRylander wrote:

    I hope your financial analysis is a couple of orders of magnitude better than your work on this article, which makes the same errors as most other Obama press releases.

    Not only does it dramatically overstate (50 million uninsured? unusually dishonest propaganda) and mischaracterize the problem (the problem is actually too much insurance, that is, too much isolation from the cost of health care and from personal cost/benefit analyses, not too little), but it also fails to note that the bill seems primarily designed to drive private insurers out of business (insurance now being used only to cover the already ill, the rest paying $750 or less a year--and that to the government!), fitting with Obama's delusional claim that the private sector is doing fine, but the economy is still doing badly, because the government isn't growing fast enough. This is a comically trendy, PC, euro-socialist analysis, which has the tremendous virtue (if you want to call it that) only of transferring ever more power and money to Progressives, which seems to be the real point and only unique accomplishment of Progressivism all over the world, but has the comparatively minor downsides of pushing this country over the fiscal cliff and ever closer to government health care mediocrity.

    For those saying that other countries show that Obamacare will work, think again: when one compares like to like, same ethno-cultural groups to same ethno-cultural groups, American outcomes are far better. The reason Sweden gets more bang for the buck is that they're insuring Swedes--compare Swedish economic and health status here to Swedes there, and the story becomes clearer.

    Leftist activists' success in literally taking over the American academy has left America with the lowest quality PC intellectuals in her history--and this Obama analysis and many of the responses to it illustrate that all too well.

    BTW, what America needs is not (1) its current system, which is layered with government-imposed moronic requirements and a quasi-union professional guild system to jack up salaries, and not (2) socialized medicine, which works only so long as some other country does the R&D and the patient population has a strong culture of achievement, order, and hard work (e.g., Sweden, Germany), but (3) a free market approach combined with a government supplied safety net--and Obamacare is NOT designed to do that. It's designed to reward and build dependency and ensure the collapse of private healthcare (only buy insurance when you're sick--they have to take you if you sign up the day after you find out you're ill, and you can free-ride until then), thereby ultimately letting the government impose single-payer price controls and ultimately transferring power and money to Progressive "experts" who will do the thinking for all of us.

    This is a moral and economic joke ("government efficiency?" Price controls? Socialism? As the way _forward_ _economically_?), but it is completely predictable once one realizes that it's goal is to transfer money and power to Progressives so that they can do what they do best: run others' lives.

    I'm afraid the Fools who actually believe that socialism outperforms a deregulated free market (and fully realizing we have neither now, though we may be closer than we realize to the former given Medicare and Medicaid) are genuinely living up to the name this time.

  • Report this Comment On June 29, 2012, at 1:22 PM, Stygeon wrote:

    Well, I am for anything that turns us away from the profit-driven healthcare machine. As long as the money-mongers are in control, nothing will truly be changed. There is too much money involved; as long as that is the way it is, men, women and children will be the very LAST consideration. Healthcare should be a non-profit system.

    You know, I live in Houston and you should see all the money down here in the medical center. The hospitals are more like works of art rather than a place of healing. I am not saying they should not be state of the art but the buildings and all the trimmings cost billions of extra dollars. How many of us who barely have healthcare could be treated better, if those billions were actually spent on the people! AS long as it is for-profit, the money people will line their pockets and everyone else will have to suck hind teat.

    Look at the hospital chains up on charges for fraud and mal-coding. These are directives from the money guys and they will defraud everyone to make an extra buck. If it was non-profit, a lot of that crap would go away.

    We are one of the only "civilized", and I use the term loosly for us, countries who have such a primitive healthcare system. They put out down-right lies and counter propaganda to show how bad the service and treatment is in other countries but they lie to everyone. Don't beleive me, go ask the average Canadian, Scott or Brit how their healthcare and treatment is and they will tell you it is great. I know people in Scottland who pay nothing for prescriptions and the doctor will come to their house if they are too sick to go. The government even helps them to buy a car so they can get her and her kids, 2 who have down syndrome and she has systemic lupus. All of her meds come in a big box and when she runs low, all she has to do go the Rx and get a brand new box. She pays nothing for it. My wife, who has systemic lupus cost 2 thousand a month for her meds. So are you telling me the Scottish govt eats the cost on the meds? Hell no, it's the money-monger here who have a captive audience who has to pay this.

    This country has gone to hell, and the healthcare system is just the tip of the iceberg. We still live in a feudalistic country ruled by the economic oligarchy run by people like Mitt Romeny. Why does no one hold him accountable for shipping his money into offshore Caribean accounts so he can get away with it, like the rest of the new American Aristocray, who feel they are entitled to everything and find nothing wrong with screwing the rest of us?

  • Report this Comment On June 29, 2012, at 1:26 PM, whereaminow wrote:

    Morgan Housel,

    ----> I protest. It's selfish because that person pushes the cost of their inevitable medical care onto those who pay for insurance. The mandate forces personal responsibility. <-----

    This is a completely non-economic and 100% false statement.

    The reason costs go up is because hospitals are forced by law to treat those who do not have the means to pay, causing a rise in premiums for others.

    Before hospitals were forced by law to make these treatments, private church hospitals performed this function through voluntary donations. And guess what? Nobody was ever left for dead on their doorsteps.

    Like most "journalists" on this topic, you can't see past the last decade or so of intervention (if even that) to see how much government regulation has actually caused this problem.

    Let's use another example. Say insurance companies were FORCED to pool football players and IT guys in the same risk pool and with the same premiums. When the IT guys used basic human reasoning and realized they were getting screwed out of this deal, would it make them selfish to want out? Of course not, that's basics human nature.

    You can protest all you want. You are wrong. Your argument in NON-economic, nonsensical, condescending, implicitly violent, and immoral.

    David in Liberty

  • Report this Comment On June 29, 2012, at 1:29 PM, Stygeon wrote:

    I am not a great fan of the new healthcare law, but something had to be done. I would like to know the criteria for the word "affordable" in the affordable healthcare act. I am covered and I use the term loosely here as well; I pay 250 bucks a month for substandard service and coverage. How much is affordable? This whole thing is whacked on both sides of the fence.

  • Report this Comment On June 29, 2012, at 1:33 PM, Stygeon wrote:

    That is why everyone has to have it, so it spreads everyone's cost broadly across 300 million people. Everyone should have the right to the same coverage, no matter who you are. Of course the money guys will protest coz they are only making billions in profit instead of gozillions...it's the same song second verse...

  • Report this Comment On June 29, 2012, at 1:34 PM, RavenManiac1968 wrote:

    @ poorer thanu

    <<Free markets and personal liberty is about making decisions and reaping consequences. Accidents happen and life is not fair. Explain to me why I should have to pay for your accidents and bad habits.>>

    You are already paying for other peoples accidents and bad habits. Your car insurance is based on a risk pool of drivers, some bad drivers and some good drivers. Same with health insurance, it is based on a risk pool of people, some healthy people and some unhealthy people.

  • Report this Comment On June 29, 2012, at 1:52 PM, johnsyn wrote:

    And a lot slipped thru unaddressed. Last I knew, certain states and a number of "contributor groups" were exempt to buy their vote. How can a tax be levied against some states and citizens and not others? isn't that civil right violations up the yazoo?

  • Report this Comment On June 29, 2012, at 1:54 PM, WmMatz wrote:

    Firsk,

    There are a number of flaws in your premises, although I concur with the need for change.

    1. Those systems are not "better by any metric"; overwhelmingly, reports are that those systems offer better (and broader) basic care, their results are much worse for cancer survival, etc.

    2. US costs reflect an indirect subsidy to the rest of the world for drugs, advanced devices, and cutting-edge surgery.

    3. Waste figures for Federal health programs are staggering. E.g. a 1990 study estimated Medicare waste/fraud at $100 billion, 22 years ago!

    4. The VA health system, while improving, hardly inspires confidence in Federal health management competence, either.

    5. One good (albeit not original) aspect of Obamacare is the purchasing exchanges. California had such a program called HIPC. I set up a company plan under that program, and we actually had better rates than Fortune 500 companies. Pooling of individuals and small businesses does work.Amazingly, the cost to CA was zero, as admin was copvered by a small surcharge.

    6. While I have not seen any comprehensive studies, I suspect that US costs are significantly affected by different demographics. E.g., Europe's birthrates are well below replacement.

    7. Finally, you are right, all systems have some form of rationing. The debate has been dishonest in failing to recognize that.

  • Report this Comment On June 29, 2012, at 2:17 PM, Turfscape wrote:

    "Nobody was ever left for dead on their doorsteps"

    David...non-verifiable statement, and heavy anecdotal evidence suggests otherwise.

    Not picking a fight with the premise that government intervention cause many of the issues we face...but that statement doesn't work for your case.

  • Report this Comment On June 29, 2012, at 2:48 PM, Stygeon wrote:

    I think one other point I would like to make is we have the insurance game bass ackwards. In Japan, the Japanese have a book of charges. Everything from a hang-nail to cancer surgery (sp) is in there. Insurance companies have to go by the book if they want to participate in the system. We have let the insurance companies dictate the rules for too long. It borders on racketeering...at least if we did some of those things individually, we would be in jail.

    In Houston several years back we had a hurricane and there were many claims for repairing the rooves of houses who were damaged by said hurricane. Now, most of these people including myself, had been paying for many years for protection, (the racket), and when we needed it, Farmers tried to bail on the whole thing. It got them kicked out of the state for a time. I submit, the guys on top should have been thrown in jail for racketeering. What they did was no different than what the mafia has been doing for years.

    We need to take control of this situation ourselves and force these crooks to do our bidding or not allow them to participate... not the other way around.

  • Report this Comment On June 29, 2012, at 2:49 PM, SpendLikeGreece wrote:

    The fines/taxes are not that bad. I will gladly pay the $300-$3000 over the next several years instead of giving an insurance company $8,000 dollars a year. Most years I don't spend more than $2,000 on hospital costs anyway. Just too bad that the Government is taxing us for being citizens. There will still be millions of uninsured illegals that we all have to pay for too. I really think that they need to solve the housing problem by creating an "Affordable Home Act". AHA will mandate that everyone buy a house or face a tax. It's completely constitutional and will help to lower health care costs because people that are not out sleeping in the elements are less likely to catch a cold or pnuemonia. Then, we will need to pass the "Affordable Car Act" to force people to buy new cars every year or face a tax. This way the older cars that damage the environment will be taken off the road in favor of cleaner, newer, more efficient cars. ACA will also be a big help to our automakers. As for the people of this country? Who cares? Tax 'em all until the revolt!!!!

  • Report this Comment On June 29, 2012, at 3:10 PM, sothham wrote:

    I think it's strange that anyone thinks they are knowledgeable enough that they can generalize a population of almost 50 million un-insured people into overweight, self-induced ill health. It's fundamentally ignorant. Rightly or wrongly, we are one of the only "first world" countries that has no provision for all citizens and basic healthcare infrastructure for all. Buy an island with a great fence if you want to hide yourselves from the realities of everday society. We're not perfect and surely we all have an obligation to make our physical and social environment the very best that it can be, which includes contibuting to all the social issues that we face, whether they are yours or your neighbours, and dealing with what some of you seem to find the less "desirable" problems. The ultimate success and wealth of this nation is directly linked to the welfare of all it's citizens. And that doesn't mean the rich shouldn't be rich. Just that it shouldn't be so disproportionate that millions of people suffer.

  • Report this Comment On June 29, 2012, at 3:17 PM, smokeight wrote:

    I have to take issue with comments about socialism, slippery slopes etc. I work in the most socialistic medical care system in the world, the Veterans Health Administration. Polls show that veterans are pretty happy with all aspects of the health care they receive.

    Germany, for example, has a completely private system. Their hospitals, doctors, and staff are all non-government workers. Their health insurance is private also but, major difference here, the health insurers are NON profit.

    Switzerland and Taiwan reformed their health care at the same time the US failed to adopt "HillaryCare" much to our detriment. I agree with those who have pointed out the selfish ignorance of those opposing health care reform for America.

    Cheers!

  • Report this Comment On June 29, 2012, at 3:17 PM, mmclearlake wrote:

    As a small business owner, here is my 2 cents worth. I currently have 40 employees. When I reach 50 employees I will be faced with a fine (tax) of $40,000. This will increase by $2,000 for every person I hire after that. The amount of profit I could expect to make by adding 10 additional employees would be wiped out by the fine. Also, since this is a fine, I cannot expense this to offset my income. What incentive do I have to hire more people? None! In my shoes, this is definitely a job killer!

    When society puts into a place a system that allows non producers to pass laws that affect the producers, it is on a path of which we may not be able to recover.

  • Report this Comment On June 29, 2012, at 3:18 PM, Firsk wrote:

    WmMatz,

    re

    1. Most epidemiologists use infant mortality as a leading indicator, least influenced by extraneous issues, and the US doesn't do very well there. Heath metrics are complex, and we may do well at adding a few months to the survival of cancer patients in some categories, but it is very clear that overall results delivered by our health care system as a whole are much worse than countries spending half what we do, or less. It's hard to argue our private system is working well.

    2. True, there is an element of subsidy we provide for research, though much of that is funded through our hopefully profitable pharmaceutical industry and our hopefully otherwise subsidized research institutions. Funding this by jacking up health care costs overall is a particularly inefficient mechanism. Even so, tho sis in no possible sense responsible for us paying twice or more what other countries pay as a % of GDP.

    3. Private and public solutions both have inefficiencies and potential for waste. Private insurers waste money figuring out how to deny or limit care and maximize shareholder profits. Government entities have different levels of inefficiency, and private companies figured out ways to take advantage of lax Medicare rules and enforcement to steal from the public purse. I think the global experiments show that overall, government led or highly regulated solutions are better at delivering most care and have lower waste than our private insurance system does.

    4. The VA gets pretty high ratings, particularly from doctors who appreciate not being constrained by insurers, and who are able to do what is best for the patient.

    5. Agree- the exchanges are one of the most optimistic things for me- I hope I can join one, as I've been an on the individual insurance market since 1985, and you are screwed as an individual. If you have health problems, the market doesn't want you at all.

    6. Demographics are indeed a factor, but mostly work in the US favor. Europe and Japan are aging more rapidly than we are.

    7. Rationing has to be part of the discussion. Also, if we actually regard some level of heath care as a public good- like having clean air or water or public safety services.

    A lot of this discussion is brought about by those who see health care (and often everything else) as a purely an issue of individual responsibility. In a libertarian fantasy world, that might be true. Others of us- myself included- see individual responsibility as playing a big role, and exercise, eat healthfully, don't smoke, etc. But we also recognize a crapshoot aspect to life- that drug resistant TB is a threat we can only address on a societal level, and that accidents or illness can come at any time to anyone, and that insurance is the way we efficiently address these uncertainties. Then the question comes how to rationally structure and pay for it. Rationing shouldn't be an accusation, it's a necessary part of the discussion.

  • Report this Comment On June 29, 2012, at 3:40 PM, Firsk wrote:

    mmclearlake,

    "I currently have 40 employees. When I reach 50 employees I will be faced with a fine (tax) of $40,000. This will increase by $2,000 for every person I hire after that…. I cannot expense this to offset my income. What incentive do I have to hire more people? None! "

    OR, you could offer heath insurance as a benefit to your employees (which you can have them pay for a portion of, and which you can expense), and adjust your pricing to allow for your increased costs, knowing that all your competitors are in exactly the same reality. If you are using this as a rationalization for not hiring, it doesn't say much for your business analysis.

    In the US we started doing providing health insurance through employers only because of wage and price controls during WWII, when it was an unregulated benefit that could be used to attract workers- a huge mistake in my view. But were you lobbying for single payer, or for divorcing health insurance from employment?

  • Report this Comment On June 29, 2012, at 3:43 PM, interdependent wrote:

    Disclaimer: I am a health care provider, not an investment banker.

    I'm writing this note to procrastinate a little longer, instead of collecting my fees from insurance for June. Getting paid should be the highlight of my entrepreneurial day. But I feel aversion when it's time to get paid, anything at all to avoid those phone reps and websites, tracking denied claims into a maze of computerized deception.

    I agree we need a national single-payer health care system, like every other country in the industrialized world.

    The Heritage Foundation, health insurance lobbies, and other right-wing groups crafted rules designed to prop up the crooks profiting off our illness. Today they may call it "Obamacare", but it was always a conservative, reactionary lobbying effort to preclude socialized medicine and enshrine private insurance companies as the national institutions of health care instead. The opposite of socialized care, Obamacare does nothing for cost control, and little for universal coverage.

    And now conservatives want to tear down their own creation, send us right back to where we started, and live without universal care through another decade or so of debating about individual freedoms and market solutions.

    If the healthcare fairy visited us tonight and gave us a national single-payer system, I would collect drastically lower reimbursements (single-payer cost control) for my services. As a health care provider, I would happily give up 10 - 30% of my fees just to save the time and headaches I devote to trying to collect my fees from 'insurance' companies. Why? Because I'm selfish! I would come out ahead from day one. Here's how:

    I could use all that time, now wasted trying to get paid, to serve more people increasing my revenue and decreasing my overhead, while I myself could live a longer happier headache-free life. Collecting from insurance companies is such a demoralizing part of my business that I put it at the very bottom of my to-do list. Insurance companies successfully keep a portion of my labor on their balance sheets every year (a 'tax' or a 'penalty' you decide) just by denying claims incorrectly and repeatedly and wearing me down.

    I know a national single-payer system would eliminate thousands of real jobs for medical office assistants, and every one of those thousands of people who work in the health insurance industry. Those are not just numbers or statistics. Those are real people.

    But those people don't make you feel better. They don't add one thing to your health.

    Do they?

    Unhappy in Health

    p.s. I have to quit entertaining myself now, and (yuck!) try to collect some of my pay.

  • Report this Comment On June 29, 2012, at 3:45 PM, whereaminow wrote:

    17 years ago, the great Austrian School economist Murray Rothbard laid out the problem so perfectly, yet of course no one listened.

    He wrote:

    "One of Ludwig von Mises's keenest insights was on the cumulative tendency of government intervention. The government, in its wisdom, perceives a problem (and Lord knows, there are always problems!). The government then intervenes to "solve" that problem. But lo and behold! instead of solving the initial problem, the intervention creates two or three further problems, which the government feels it must intervene to heal, and so on toward socialism.

    No industry provides a more dramatic illustration of this malignant process than medical care. We stand at the seemingly inexorable brink of fully socialized medicine, or what is euphemistically called "national health insurance." Physician and hospital prices are high and are always rising rapidly, far beyond general inflation. As a result, the medically uninsured can scarcely pay at all, so that those who are not certifiable claimants for charity or Medicaid are bereft. Hence, the call for national health insurance.

    But why are rates high and increasing rapidly? The answer is the very existence of healthcare insurance, which was established or subsidized or promoted by the government to help ease the previous burden of medical care. Medicare, Blue Cross, etc., are also very peculiar forms of "insurance."

    If your house burns down and you have fire insurance, you receive (if you can pry the money loose from your friendly insurance company) a compensating fixed money benefit. For this privilege, you pay in advance a fixed annual premium. Only in our system of medical insurance does the government or Blue Cross pay, not a fixed sum, but whatever the doctor or hospital chooses to charge.

    In economic terms, this means that the demand curve for physicians and hospitals can rise without limit. In short, in a form grotesquely different from Say's Law, the suppliers can literally create their own demand through unlimited third-party payments to pick up the tab. If demand curves rise virtually without limit, so too do the prices of the service."

    http://mises.org/daily/6099/Government-Medical-Insurance

    David in Liberty

  • Report this Comment On June 29, 2012, at 3:50 PM, Firsk wrote:

    @ Eric

    Your arguments are flawed and ideological, not fact based. In the real world laboratory, getting government involved, either as a single payer or as a regulator of the market, has consistently lowered overall costs. This is true for advanced, homogenous countries like Sweden (single payer) or Switzerland (regulated private market), but also for very diverse and for poorer countries- Canada and Taiwan being examples. All other industrialized countries waste much less of their economic output on bureaucracy and overhead for health care, and our own government systems- VA and Medicare- operate far more efficiently than the private insurance market does.

    There are fundamental aspects to the nature of heath care- particularly catastrophic care or accident care- that make it impossible for a competitive market to deliver the results you cite. You are not- as an unconscious accident victim- going to be able to do an analysis of competing care options.

    You say you don't ask what it costs when you go to the doctor- well, I DO ask, because I'm one of those who must buy insurance on the individual market, and I have a catastrophic policy on which I have never collected a dime of coverage in 20 years. It doesn't help to ask, though there are some providers here who will cut rates by 50% if you pay cash and they don't have to deal with insurance company paperwork. Your assertion that such catastrophic policies are cheap is incorrect. Insurers do not want to deal with individuals- the individual market does not work. The catastrophic policy for myself and my wife, both healthy non-smokers, is $823 per month, with a $7,000 individual deductible, $14,000 family deductible before coverage begins at 60- 80%. That represents almost 20% of the median income just for premiums, before any actual medical expenses. How does that work for the average person? If I were in a big group or company (or exchange, hopefully) that coverage would be better and much cheaper. The cheap policies you hear about often don't cover much when you actually read the fine print- part of what ACA is intended to address. Of course if you are 25 years old, it's cheaper to get coverage. On the other hand, if you have ever had any health issues in your history, the private market will simply refuse to offer coverage at all. I will say it again- the unregulated private insurance market does not work, and cannot work, so long as converge can be denied, and coverage is not essentially universal.

  • Report this Comment On June 29, 2012, at 4:13 PM, smokeight wrote:

    David in "Liberty", i would suggest you read "The Healing of America" by T. R. Reid. I think you probably don't want to be bothered by factual information but, just in case, I offer the option.

  • Report this Comment On June 29, 2012, at 4:21 PM, Firsk wrote:

    David in Liberty,

    You say: "Only in our system of medical insurance does the government or Blue Cross pay, not a fixed sum, but whatever the doctor or hospital chooses to charge."

    Ask any provider working with Medicare or the VA, or in a country like Germany, France- oh, any other industrialized county for that matter- if that is an accurate depiction of reality. Even with private insurers here fees are negotiated- it's just that the actual consumer does not get a place at the negotiating table. Socialized systems have done a much better job of containing costs and delivering care. And in fact, many health risks- infectious diseases, for instance, or pollution- are socialized by physical reality This reality is at odds with your ideology.

    If we're going to be quoting Austrian economists, I'll quote one who at least sometimes made sense:

    “Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance — where, in short, we deal with genuinely insurable risks — the case for the state’s helping to organize a comprehensive system of social insurance is very strong.” -Friedrich Hayek.

  • Report this Comment On June 29, 2012, at 4:28 PM, RBinSLC wrote:

    As a small business person, the most distasteful part of my job is the annual selecting of a health insurance plan for my employees. Those who oppose ACA like to point out there will be "big" increases in premiums. Do they mean like the 15-25% increase my company has experienced in each of the last 5 years?? Every year we are forced to reduce coverage at increased costs.Then there is always that nagging feeling that maybe you should hire only young workers because the premium on someone in their 50s is 3x that of a 20 something. Oh and check to make sure there is no family history of heart desease, cancer, etc.. Why do we bother to have age discrimination laws anyway? Ultimately, no one is happy...no me because my costs go up and not my employees because their costs go up and coverage is less. It's a no win situation. Whoever thought that it was appropriate for a business...particularly a small one...to have the responsibility for health care decisions for employees? Health care is a civil issue...not a business decision...except of course in the US. ACA is not the best answer but it is at least a move in the right direction. However as long as long as Insurers have lobbyists, no one should worry about them getting hurt. It's our system and unfortunately we are stuck with it for at least as long as I will live. There is just no better feeling than knowing that the people in charge of paying for your health care (insurers) profit from denying it.

  • Report this Comment On June 29, 2012, at 4:35 PM, whereaminow wrote:

    Firsk,

    F.A. Hayek also advocated competing currencies, which would destroy Obamacare overnight. He also pointed out that the more a government grows, the more likely it is to be filled by the worst of society. Finally, he won a Nobel Prize for showing how government intervention in banking (through manipulation of the interest rate by the creatures it creates) causes the business cycle.

    That at one time he postulated on the possibility of health insurance doesn't make him a genius. It makes it clear that this was one aberration in an otherwise stellar career.

    Know your Hayek.

    David in Liberty

  • Report this Comment On June 29, 2012, at 4:47 PM, stomachfool wrote:

    I live in a 'socialist' country which has provided free healthcare to all 'forever'. The cost as % of GDP is a fraction of what it is in the US!

    Is it socialism? Well, if it is, then every insurance company is a socialist!

    It's not really rocket science. When everyone pays, you get benefits of scale and avoid cost of fraud, administration, over-prizing, etc.

    You also promote 'preventive maintenance' and at the end of day, the only REAL way to reduce health care cost for the society at large, is to make people more healthy.

    Eventually, society will bear the cost of poor health whether people are insured or not. If you are sick you cannot contribute to the production.

    It's like owning a factory and leaving 20% of the machinery on the manufactoring floor out of order. You save on the repair bill, but you leave your capital investment unproductive.

    I live in a 'socialist' country which has provided free healthcare to all 'forever'. The cost as % of GDP is a fraction of what it is in the US!

    Is it socialism? Well, if it is, then every insurance company is a socialist!

    It's not really rocket science. When everyone pays, you get benefits of scale and avoid cost of fraud, administration, over-prizing, etc. You also promote 'preventive maintenance' and at the end of day, the only REAL way to reduce health care cost for the society at large, is to make people more healthy.

    Eventually, society will bear the cost of 'poor health' whether people are insured or not. If you are sick you cannot contribute to the production.

    It's like owning a factory and leaving 20% of the machinery on the manufactoring floor out of order. You save on the repair bill, but you leave your capital investment unproductive.

    Although I live in a 'socialist' country I am infact a conservative, albeit in it's European meaning. Yet, in my view, public - or mandated - healthcare is not socialism. It's altruism and altruism is what makes man distict from animal and the very reason the human race is the most successful species so far.

  • Report this Comment On June 29, 2012, at 4:51 PM, ErnieC53 wrote:

    Having read (most) of the comments here I find it not a little disquieting that although a few have touched on the periphery of a basic problem with this (and many, many other) issues, no one has confronted the condition of integrity throughout the discussion. A few - on both sides - have mentioned the need to contain the fraud and abuse costs but even these have addressed the problem from a reactionary, rather than proactive, stance.

    You can legislate until the cows come home but accomplish little until or unless a sizable majority at least of those your laws mean to control practice integrity. We seem to have reached a point in this country - and indeed with the planet - from which we attack every problem from the point of view of "How can I keep the other guy from screwing me?" rather than from the position of "What's fair so I don't screw the other guy?"

    Certain industries *should* be socialized (and this from a staunch conservative!). Someone up there said something about considering the 'public good' and he/she is right. That is, after all, the basic premise of taxation, correct? We all have to contribute for those needed services for which none of us singularly can provide; national defense being a prime example as clearly defined in our Constitution.

    Certain career paths should be pursued by individuals whose motivation is more altruistic than economic! Healthcare provider is certainly one of those. The rest of us, however, must realize that doctors and nurses have to eat too. :-)

    A few more who belong on the list are police/firemen, educators, insurers, and - now hold on to your hats - elected government officials.

    E

  • Report this Comment On June 29, 2012, at 4:52 PM, mtf00l wrote:

    @whereaminow

    You made me laugh with that last one;

    "It makes it clear that this was one aberration in an otherwise stellar career."

  • Report this Comment On June 29, 2012, at 4:55 PM, mtf00l wrote:

    @ErnieC53

    Warmer...

  • Report this Comment On June 29, 2012, at 5:12 PM, EBJG wrote:

    So where will the money come from to treat illegal immigrants (estimated between 12 and 20 million)? Under ruling by the Supremes (or somebody) of some years ago, we are required to educate them and give them medical treatment (most of them show up at emergency rooms, and you know how much THEY cost). And don't forget the pregnant women from over the planet who show up in time to have their children born here, thus giving them citizenship. Do you know what obstetrical care costs these days?

    This problem exists with or without the ACA. Anyone have an answer to this problem?

  • Report this Comment On June 29, 2012, at 5:20 PM, MissionFocused wrote:

    Lots of interesting comments but I don't see many that address how companies with low paid staff that they do not currently offer insurance to will be able to afford the cost of covering those employees. There are lots of industries that have low paid staff without insurance because they cannot afford to offer it. This will add a huge cost to those companies which is why so many companies asked for waivers. I am not sure how these companies will get around the law but they will be forced to in some way. If you have a lot of $8 an hour employees that you currently do not have in your insurance but now you have to put them in the cost increase is staggering.

  • Report this Comment On June 29, 2012, at 5:57 PM, skypilot2005 wrote:

    On June 29, 2012, at 11:25 AM, Charliechap1980 wrote:

    “Can I just say that coming from England where we have the NHS, where service's are free at the point of delivery.

    I cant believe anyone would vote against better medical care, especially the poor. Its so sad that America is run by companies, greed and immorality, it is even if you don't think so. Nation of the free, Nation of the hypnotised maybe.

    Ps im not saying we are perfect over here, far from it, but you have to look after the poorest in society, and that will give you the moral high ground. No wonder other countries in the world look at the US and think your hypocrites.”

    How soon we forget WWI, WWII and The Cold War. Remember The Berlin Wall?

    You couldn’t afford the NHS if it wasn’t for us protecting you and the other countries of Europe.

    That is a fact.

    Now go pick on some Irish women and children.

    Sky

  • Report this Comment On June 29, 2012, at 6:22 PM, littlemonk01 wrote:

    Why is ther Media hiding the part of the health bill about the 3.8 % tax on selling our homes after 2013?? Fluking all the Seniors who want top down size. Thanks O.B. and Media!

  • Report this Comment On June 29, 2012, at 9:02 PM, Firsk wrote:

    littlemonk01 asks:"Why is ther Media hiding the part of the health bill about the 3.8 % tax on selling our homes after 2013??"

    Because it doesn't exist.

    http://www.snopes.com/politics/taxes/realestate.asp

  • Report this Comment On June 29, 2012, at 10:21 PM, OzarkHarry wrote:

    Two points:

    @Stomachfool

    Forced altruism is not altruism.

    Shouldn't ALL citizens taking part in our new health care system be REQUIRED to provide all data necessary for them to be entered and documented to be used as necessary for organ donations. After all that is the humane thing to do. Or don't you care about all those desperate people needing organ replacements? Remember, they can't afford the procedure and many times they can't actually find the organ. Isn't this the "right" thing to do.

    Just like Obamacare is the "right" thing to do?

  • Report this Comment On June 30, 2012, at 12:43 AM, Tropicwade wrote:

    I am amaze at how you american babble about paying health insurance. Do you pay insurance for your cars and trucks? How is it that you are so comfortable to support wars that cost taxpayers billions every day. But complaint if the lesser fortunate americans benefit from your health dollars. when you pay insurance you are paying it for your yourself the system is now asking other to pay for their own health care. I live in the caribbean where we can walk into a hospital and have free health care. we don't complain that our money is helping poor people. Your country gives million of dollars to countries around the world to buy weapons to kill and maim (Egypt for example). But you american love your gun. so what?

  • Report this Comment On June 30, 2012, at 12:49 AM, SultanOfSwat wrote:

    @OzarkHarry

    Third point:

    Making investments in the stock market is always a gamble. Like GAMBLERS, some are better at it than others. Since INVESTING = Gambling, all FOOLS should be charged a Sin Tax. ( Maybe 50% of your winning!! ) That way we can all pay for the ACA out of our gambled winnings. Let's not be selfish !!! We have an obligation to do the "right" thing.

    Oh, by the way. Forget about our losses when we make a bad investment, we shouldn't be allowed to right that off either. Let's be fair, our hard earned money is being GAMBLED anyway. So if you can't afford to lose, dont play!!!

    This is TRUE SOCIALISM, let us not be called CAPITALISTS.

  • Report this Comment On June 30, 2012, at 7:11 AM, skypilot2005 wrote:

    A good analogy maybe looking at United Parcel Service verses The Post Office.

    Looking at the average customer wait time between the two is eye opening.

    Sky

  • Report this Comment On June 30, 2012, at 7:19 AM, Tropicwade wrote:

    It is so strange how Americans have such a distorted concept of socialism as if it is evil. It is capitalism that causes the 1% to sometimes live like blood suckers off of you.Socialism speaks of love ,care and concern for the less fortunate in society. I grew up poor in a country. if it were not for this philosophy that you hate so much, I would not have had an education. We look after the less fortunate, the old. Every primary school child can have a meal. the sick are taken care of. Sometimes you have to put a crutch under a man until he can carry himself. Have you selfish people ever considered what will happen to you if you lose your jobs, Have a prolonged sickness? Some of you that criticize and go to chuch must read your bible and see that God always provide for the poor. A Jew could not reap the corner of his fields and when reaping he had to leave what had fallen on the ground for the poor, widows and fatherless. I wonder what you pure Capitalist would so about that. Please under stand that Socialism is not COMMUNISM. And being less fortunate does not equate to being lazy.

  • Report this Comment On June 30, 2012, at 9:30 AM, bluesguy84 wrote:

    The biggest problem with both the previous system and ACA is that neither one is capable of controlling health care costs....

    The person receiving care is totally disconnected from the actual cost of the care. Until that problem is resolved we will have escalating health care costs, which will then drive up insurance costs, "wash-rinse-repeat"....

  • Report this Comment On June 30, 2012, at 3:33 PM, nonquam wrote:

    There are Pros and Cons to everything.

    My nephew, age 40 something , living in the UK with the National Health System(NHS) suffered a heart attack and was diagnosed serious enough not be allowed to leave the hospital until heart surgery was performed .He was after initial treatment able to move around as if nothing ever happened but had to join the eight week waiting list for surgery . Consequently he took up” residence “ in the hospital, relaxing and no anxiety about the cost ,waiting for his turn on the table which arrived after six weeks when his name reached the top of the list. His home is about a 10 minute drive from the hospital . All went well and he is working full blast and living in a healthier condition.

    Two years later his father, age nudging 70, suffered a TIA (mini-stroke) and was subsequently diagnosed as also requiring heart surgery. He was able to live at home and was given the choice of joining a seven week waiting list or enter a Private scheme and pay the expenses himself. His surgery was performed within two weeks under the Private scheme where the same surgeons form a Group ,lease the hospital facilities and provide care with its team of nurses in their employ separate from those in the NHS. He too is alive and kicking.

    Unfortunately and inevitably a government run system will result in headlines such as the following links describe.

    http://www.dailymail.co.uk/news/article-1253438/Mid-Stafford...

    http://www.telegraph.co.uk/health/healthnews/9356064/Six-oth...

  • Report this Comment On June 30, 2012, at 3:46 PM, altrue1090 wrote:

    I'm from Massachusetts. We have had Romneycare for several years. 65% of the residents here like Romneycare. Our unemployment rate (6%) is 2% below the country's. Romneycare stimulated the health care industry here to hire lots of people. Besides doctors and nurses, physical therapists, x-ray technicians, medical assistants, nurses' aides, etc. Besides getting everyone into health insurance, it turned out to be a jobs program too. I wish Romney would take more credit for it.

  • Report this Comment On June 30, 2012, at 8:30 PM, evn wrote:

    "I'm healthy now, I have health insurance, why should I care about anybody else? Seems reasonable."

    Pinkerton, my point was to show just how utterly selfish and unaware many of these comments are. It is more than strange.

  • Report this Comment On June 30, 2012, at 11:56 PM, Uloof wrote:

    I believe it is a right of every American to have affordable healthcare.

    Please do not compare our country with any other in the world. We have a few burdens:

    - we subsidize their liberty, freedom, and ability to chose their healthcare system with our armed forces (both dollars and lives).

    - we subsidize their economies by providing freedom of trade throughout the world with our armed forces (both dollars and lives)

    - we subsidize their political systems being stabilized by our armed forces (both dollars and lives).

    Having said all that, I believe America can get nationalized healthcare right. Behaviors are the core of healthiness. If I choose to do this or that should lead to consequences There should be a consequence for behavior that leads to increased cost.

    What America has lost is personal accountability and social responsibility

    I don't post much. Thank you for reading.

  • Report this Comment On July 01, 2012, at 3:33 AM, BBLBBD wrote:

    This is an example of where liberal thinking is shallow. He identifies the problem of uninsured citizens, but in liberal thought, the only, ONLY, solution is this monstrosity of a tax.

    Is there really no other way to ensure health care to citizens who don't have insurance ?

    A massive, statist, fascist scheme is the only viable solutiion to that so-called problem ?

    The self-proclaimed "creative class" can only create with the government and statist ideas.

    I also like the expressed wonderment at how this will effect insurance companies in the future.

    The author's idealism and earnest belief that the government is the solution to all problems no longer has any validity in this fiscal environment.

    Unfortunately for this author, who has been marinatied in leftist-statist politics his whole life, things are about to get much different for him.

    Unless he was exempted from Obamacare, like the Congress that voted for it, his life is about to get much harder, uglier, and poorer.

    Like the rest of us, his life expentancy just went down; his quality of healthcare went down. He's not going to get the treatment that people get now.

    Remember, in the words of Obama: "Grandma [or Grandpa] may need the knee replacement, but perhaps the pain pill is the better choice..."

    We will all be Grandma or Grandpa one day....and as of Thursday, our option is the pain pill.

    Let's not play make-believe anymore, people. Let's get real. These leftist/statist are not grounded in reality and the stakes just got really, really high.

  • Report this Comment On July 01, 2012, at 11:18 AM, minipearl3 wrote:

    When people travel a 100 miles to get free medical care at the fair grounds in Virginia by doctors giving their time to treat adults & children you know there is something wrong with our medical care. This may be the only way to get any care. Sad state of our medical, dental & optical care!

  • Report this Comment On July 01, 2012, at 3:26 PM, stomachfool wrote:

    @OzarkHarry

    Obviously altruism cannot be forced, but altruism does mean you do what you can for the better of others in the belief it will somehow be reciprocated.

    You cannot plan poor health - it may happen to you even if you don't gamble with your life.

    Fair point on organ donation. That is another form of altruism. I have registered as a donor although I sure hope I will never need to receive. But should I need it, I won't have to worry that it will bankrupt me.

    @those who beleive US tax payers are indirectly paying for European health care

    Your military altruism is well known. Kudos for helping to make the World a safe(r) place. (Safer for Americans too, hence it's yet another form of altruism). If you can afford this investment, surely you can afford a good health care service - certainly one that may cost you only half!

    The cost of the most expensive European health care service, both in absolute $ per capita and as a per cent of GDP, is about half of yours. So would you not rather pay half and get a better service?

    I think America is a great nation and I think all Americans deserve the best health care. I don't know if Obamacare is the best solution - that's for you to decide. I'm just offering a little insight into a solution which appears to be better AND cost less.

  • Report this Comment On July 01, 2012, at 5:11 PM, Firsk wrote:

    When I read the posts above, they are almost all spouting rote ideology, and very few (notable exception: interdependent On June 29, 2012, at 3:43 PM) are based on experience or actual hard evidence.

    It's interesting to see the comments above devoted to fears of some sort of massive increased expense if we address heath care for all- when in the real world every other industrialized country spends half or less per capita, covers everyone, and gets better care. Do these posters think Americans are too dumb to come up with a system as efficient as every other country we compete with? Other countries accepted the fact that the market for health care is fundamentally different from the market for toasters or cars, and addressed the problem rationally.

    The fact that we have spent a lot of money on a military that has, among other things, helped ensure the freedom of Europe by taking on much of their defense burden in the Cold War may be true, but it is completely and totally irrelevant to the subject of health care. If we spend a lot on defense, why wouldn't we want to save on medical costs?

    And there is the knee jerk reaction that if government does it, it's going to be expensive and wasteful- only the reality is often otherwise. In reference to health care particularly, government run systems are far more efficient than private for-profit ones. Many want to count as "waste" only what is due to government inefficiencies- but to the economy, waste is waste, and our private insurance health care model is an incredibly wasteful drain on the American economy. It damages our global competitiveness. It does a particularly lousy job of servicing the needs of those who are not part of a large group or company- entrepreneurs, small businesses, or individuals. The private health insurance industry must spend huge sums marketing their products, and then even more figuring out how to deny care while engaging in a negative sum game where they attempt to shift costs of care to other businesses, and then more to confound caregivers with forms and bureaucracy in order to delay payments. A government program would have different sorts of inefficiencies, but global experience- real world experience, not ideology- would suggest that these would not be anywhere near as great as the losses and waste we now have. Government does some things pretty well, and it pays to remember that nothing government has ever done has wasted resources on the scale that private entities did in the recent financial crisis.

    Government should be tasked to do things that private enterprise can't do, or can't do as well. There are lots of these things. I'm an entrepreneurial capitalist to the core, risking my own money in my own business- I have not taken a paycheck from anyone else since 1985. But I'm also very aware that nearly everything that makes my business even possible- the rule of law and enforcement of contracts, the existence of a safe and free environment, the development of the microprocessor, sensor technologies, the internet, the GPS satellite system, and on down to the universities that educated me and our engineers- ALL are the result of government investments made in the public good by previous generations.

    All successful modern economies have both socialist and capitalist elements- using either of those terms as a pejorative label just shows you are not using your rational mind.

  • Report this Comment On July 01, 2012, at 5:45 PM, OzarkHarry wrote:

    (@Firsk - littlemonk01 asks:"Why is ther Media hiding the part of the health bill about the 3.8 % tax on selling our homes after 2013??"

    Because it doesn't exist.)

    You need to read past the part where you see the wording you wanted to see. If you have lived in your home less than two years or it is a second home/condo/cabin, or you've lived in your main home so long the capital gains enters into it, you pay the 3.8% "tax" (actually it is an increase of 3.8% on the capital gains tax.)

    It isn't just the "rich" who will pay this.

  • Report this Comment On July 01, 2012, at 8:17 PM, Chris1016 wrote:

    Taking the 6 bullet points from the top of the article, in order:

    If an insurance company can't deny me for pre-existing conditions then what prevents me from carrying a high deductible, low cost plan until I need it and then switching to a higher cost, more comprehensive plan when I get sick?

    I don't want my kids on my insurance until they're 26. When they get out of school they should go to work for a company that offers benefits. That was one of the reasons for their education.

    If an insurance company can't charge more for older people, who use the insurance more, then they're going to have to increase the cost to younger people thereby shifting more expenses from the age group that has more, to the group that has less. Add SS to the mix and I'd say we'd better start having children by the dozen to support this.

    Restricting caps and limits will merely increase the cost of the insurance. It's a zero sum game in that regard.

    Restricting the amount a private enterprise can spend on overhead is the first step towards nationalization. Do you really want the person who just took care of you at the Motor Vehicle Department handling your health care?

    It was only a matter of time before the commerce clause was used to require individuals to spend their earnings on a specific product. It's also how we got the D of Education, D of Energy, EPA, and dozens of other bureaucratic boondoggles. I doubt the framers of the constitution anticipated the way it would be twisted to usurp powers otherwise reserved to the states.

  • Report this Comment On July 01, 2012, at 8:36 PM, Chris1016 wrote:

    Firsk:

    When you talk about how "every other industrialized country spends half or less per capita", I can only presume that you're talking about industrialized nations like Greece, Spain, Portugal, and Ireland.

    If the health care in these nations is so good, why do their citizens who can afford it come to the United States for their medical care? These other industrialized countries may have a nationalized way to pay for health services, but they do NOT receive the best health care.

    As far as the government being tasked with doing things that private enterprise can't do as well, I would have to say their is nothing the government does better than private enterprise. For instance, the D of Energy's charter called for the reduction of America's dependence on foreign oil. Some 35 years later we still import the same percentage of oil despite the DOE's $24 billion annual budget. Would you like to compare FedEx with the USPS? How about the ROI of Social Security versus the S&P?

  • Report this Comment On July 02, 2012, at 3:13 AM, Firsk wrote:

    There are many studies ranking health care effectiveness among countries. It's a complex subject, but for most metrics the US ends up near the bottom of the industrialized countries, and we spend the most per capita by a very large margin.

    While there are plenty of anecdotal accounts of individuals who can afford it coming to the US for specialized treatments- because we have some truly excellent facilities for those who can afford them- that doesn't have much to do with the efficiency of the overall health care system. We ration health care by economic status or to those with the privileged position of working for a large bureaucracy that provides insurance. Other countries ration access by using prioritized need criteria, and can have waiting lists or delays. Sometimes those with enough wealth can jump the queue by coming here- more power to them. But I can guarantee that the number of Europeans coming to the US for general care is vanishingly small.

    By lumping countries as different as Greece and Spain together, you're indicating a lack of awareness of why they have problems. Spain, at least, had a government surplus and has provided health care for all since the '80's. Their economic troubles are due to a private enterprise speculative bubble, not excessive spending on the part of their government- though now the government has to pick up the pieces of a free enterprise disaster.

    There are PLENTY of things that government can do better than private industry, or that private industry can't do at all.

    When we want a highway between two cities, we usually only need one- competitiveness is not possible, so we do it as a public good. Balkanizing commerce with a thousand toll booths is not productive use of economic energy. But road construction provides plenty of private business for road contractors, pointing out that most "public" investment is really public-private. Harbors and aids to navigation are maintained publicly for benefits to general commerce, and because if a tanker crashes into the coast, the oil spills on us all. Government has played a huge role in developing transportation systems in advance of need, as in the railroads and the interstate highway system.

    For any of us that have worked in research, it's common to see ideas and avenues for development that have great potential value, but would never provide a profitable return on investment for a company- because they couldn't be made proprietary, for instance. Government research can prove these new concepts and help make them available to the population. Vaccines are typically not profitable, require much effort and expense to develop and need constant change, but have significant public benefits. Modeling vaccine production as a purely for profit business, you run into the problem that vaccines are only effective if they get to essentially the entire population. If you ration by cost or make them expensive in order to pay for development, they fail in their purpose. Hence. they tend to have a major government component in research and subsidies. Government, in fact, is primarily responsible for eliminating the infectious diseases that claimed most of our ancestors lives.

    The higher education system in the US is a prime source of our prosperity, and it is rooted in public investment. My own father started in life on a subsistence farm, ploughing the land with a mule. Nothing in his life would have been very strange to a farmer of 4,000 years earlier. When inducted into the Army in WWII he had suffered from rickets and had never seen medical care, he was in effect a third world peasant. Because of the GI Bill he went to college, and he ended up helping design the Space Shuttle and put up the GPS satellites. Prior to that social legislation, essentially the only determinant of who got a college education was the wealth of the parents. Government programs changed that, I believe for the better.

    I'm happy to have the FAA, for all its flaws, to oversee air traffic and aircraft safety. Ditto for many environmental protections- do you want to rely on the tort system to sort out which of the thousands of polluting factories upstream are responsible for poisoning your children? Maybe years after they went out of business? Reasonable regulation for public safety is a prime task of government I would not want to leave to private enterprise. NOAA has greatly improved storm forecasting through public investment, which has benefits precisely because the information is freely given away as a public good.

    Government can afford to take a multi-generation long term view and invest in speculative technologies that may or may not pay out, and then spin off the positive results to private enterprise to build on and improve. A huge percentage or our economic prosperity is based on these long term investments in public goods- the development of the microprocessor, the internet, and the GPS system, for just top of the head examples. Possibly many space travel technologies will soon be another. The GPS system is a particularly good example, in that it could only have been implemented by a public entity, and the value to the economy comes precisely from the fact that the product- the GPS signal- is given away for free. It has revolutionized countless areas of life, from farming to civil engineering, spawned entire industries, and vastly improved public safety worldwide. It's provided a tremendous return on public investment. Government plays a huge role in starting, developing, and proving technologies that result in entrepreneurial opportunities.

    Your examples- foreign oil and FedEx vs. USPS, and Social Security, are red herrings. The first is a political and subsidy problem caused by an over reliance on private enterprise- enterprise that is seeking short term profits, not weighing the long term interests of the country, and that is heavily subsidized. It's an example of where we could not muster enough political will to do what is in our own long term best interest, which would have been to use tax policy and ending subsidies to stimulate innovation over time.

    FedEx and USPS are not comparable entities- FedEx is not required to deliver to every address every day. We can and should have a public discussion over whether such postal service is still an important public value- it may not be- but no private company is currently does what USPS does.

    Social Security is not an investment program by any stretch of the imagination, it's a transfer of payments from the current working population to those who are not working or cannot work. You can say you think this is a lousy idea, that the current generation doesn't owe anything to earlier generations for the country they inherited, but comparing it to a stock index indicates a serious lack of understanding.

  • Report this Comment On July 02, 2012, at 4:05 PM, greengirl00 wrote:

    @Plinkon

    I guess I'm one of the 'selfish' ones that doesn't want to pay for others healthcare, though I am already. I don't mind helping out with people who are working to make their way, or because of their health cannot work. My main issue is the ones who are using the system. These people are where the real costly issues come from. I don't want to be selfish by saying I won't help others. I want to help others. It's what actually drives me as one of my main motivators in life. But there is a point where people need to accept that others don't want help, and not only do some people not want help, they don't want to help themselves. The people I'm talking about are(I'm guessing are mostly government subsidized anyway, and insured) frequent flyers to the emergency room every week just to listen to the doctor tell them that they need to lose weight, eat healthy and exercise, and then go back to their fatty and carb heavy freezer food/fast food diet while they consider exercise to be a trip to the mailbox every other day (true story from my PA sister-in-law).

    These people are draining time, money, energy, and I'm not saying they're not worth time, energy and money. They're just not worth the level of resources they are draining every week to be told that their health is in their hands. And then they come back for a second, third, and fourth opinion EVERY MONTH, searching for the quick fix.

    This drain on the system and the red tape costs have a huge affect on the healthcare providers organizations. To be cost-effective, they're given 15 minutes to see each patient. This means that procedures that should happen are not happening, because time is money. For instance; a friend had an ingrown toenail that was swollen and infected. The doctor wouldn't cut it open to pull out the disconnected fragment floating around inside, he gave her antibiotics. As soon as the antibiotics ran out, the infection came back. Repetitive cycle. Til she found a friend in the medical field, who then cut the nail correctly and dug around for a floating piece causing infection. Many doctor's won't do procedures, because they are limited by their organization by time, but patients end up making several visits to treat a symptom of the root problem, costing the organization, costing the insurance, and costing the consumers.

    I want an efficient healthcare system that works together for people to provide resources, access to resources, and mercy for those who need help at an efficient price instead of an exorbitant price. But I don't want to include in it paying for "in need" people who are told what to do for their health and ignore it to the extreme. This system would need a teaching health & nutrition classes for some of these drainers, maybe even as extreme as sending them to a conference/camp type setting to unlearn habits and be walked through how to cook healthily. Some people will travel the same path because they're afraid to go somewhere new without someone guiding them. Maybe the government could enact grants for effective efficiency within insurance companies and healthcare organizations who create health care cost incentives in cooperation with clinics and hospitals, high schools, and colleges training nutritionists and fitness coaches and social workers and website programmers. If there was one government website that was a reliable source and could act as a source for common medical conditions

    There are so many valid points both arguing for and against parts of the plan, we need to take these loopholes and ensure that they don't snag and unravel our economy as well as our healthcare system. I want a system that's fair and will help, but doesn't make it easy for people to work the system by giving up and doing nothing and staying in this victim-mentality parasite state.

  • Report this Comment On July 02, 2012, at 6:15 PM, skypilot2005 wrote:

    On June 28, 2012, at 6:23 PM, TMFMorgan wrote:

    “As the Motley Fool mentioned last week, "Obama Care" is a term used by the Obama administration themselves:”

    As a result of The Supreme Court ruling, shouldn’t it be Obama Tax instead of Obama Care?

    Sky

  • Report this Comment On July 02, 2012, at 9:12 PM, skypilot2005 wrote:

    On July 02, 2012, at 3:13 AM, Firsk wrote

    “FedEx and USPS are not comparable entities- FedEx is not required to deliver to every address every day. We can and should have a public discussion over whether such postal service is still an important public value- it may not be- but no private company is currently does what USPS does.”

    Customer service is absolutely comparable.

    The average wait time for service at a Post Office is seven times greater than at United Parcel Service.

    After 10 or 20 years of Obama Tax, aka Obama Care, I say good luck getting prompt, competent health care in “The System”,

    Hopefully, President Obama and those in Congress that voted for it will be unemployed next year.

    Sky

  • Report this Comment On July 03, 2012, at 4:35 AM, BBLBBD wrote:

    "When people travel a 100 miles to get free medical care at the fair grounds in Virginia by doctors giving their time to treat adults & children you know there is something wrong with our medical care"

    Oh lordy. Where to start on this. Let's take it one by one: travel 100 miles. Generally, 100 miles by car by Interstate (we'll get to the fact they these people have cars next) takes about 2 hours. Let's say 2.5 hours when the travel is not by Interstate.

    Conclusion: those people had at least 5 hours to kill that day. 2.5 hours there, 2.5 hours back. Not to mention the time to wait for the freebies and to hang around and enjoy themselves.

    Those people had cars to drive 200 miles round trip and pay for gas. That's far. Conclusion: car plus gas. If no car, then bus ticket money, time to make the bus reservation, etc. Perhaps they hitchhiked. Then add even more time to the time spent. Does anyone believe this ?

    Five hours in travel time alone. Any drinks ? Any food ? Any smokes ? Let me guess. They packed pb&j's and water.

    Those people got something for free. Conclusion: this says more about people trying to get something for nothing instead of the health care system.

    America: where "poor" people consume more dollars, more calories, more energy, more resources than any other poor people in the world,yet expend less to live a comfortable life than their counterparts elsewhere, and not only bitch about it but have an entire "community organization" to encourage this.

    This is pure lazy and pure opportunism.

    I'm not making fun of anyone who is poor. I'm poor and unemployed. I am making fun of the knee jerk liberal reaction that does not apply any critical thought to these sad-sack stories.

    "FedEx and USPS are not comparable entities- FedEx is not required to deliver to every address every day."

    Do we need daily mail ? If you had a choice to pick up your mail once every three days would you take it ? Is junk mail that important ? If someone is so poor and so dependent on government, do they even need mail except once a month ?

    Liberal thought is so shallow.

    Where is the critical thought anymore ? Modern liberalism/progressivism/statism does have any depth to its thought.

  • Report this Comment On July 03, 2012, at 4:20 PM, ecc915 wrote:

    The fed is how many trillions in debt already? Now they want to "buy" "healthcare for everyone" ??

    Simply passing a law to "make healthcare affordable" reveals how ignorant, misguided, and naive this administration is. Anyone who has ever had a real job, had to live within their means, and had to learn real world economics should know that it is not that simple.

    The U.S. economy and health care system is extremely complex, intensly personal and private, and cannot be boxed into a centralized government program without catastrophic results. This is a recipe for utter disaster.

  • Report this Comment On July 05, 2012, at 8:14 AM, workinhealthcare wrote:

    Controlling healthcare costs is the key problem, and Obamacare lays a foundation for eventually doing that. Despite the protests of the health care industry, hospitals are bloated with staff, inefficient, and prone to error. Hospitals will not waste less money until there is less money to waste. Hospitals and providers are overpaid ---by insurance companies; not by Medicare.

    Insurance companies negotiate percentage reductions in their payments to providers and hospitals, but do little (nothing) to verify that charges reflect costs or are even accurate. Only Medicare attempts to link payments to costs, requiring hospitals to submit cost reports. The result is substantially less payment compared to payments from private insurance.

    As Obamacare rolls out, insurance companies will raise rates as they are forced to comply with new coverage mandates. Eventually they are priced out. Obamacare will fill the gap--at far lower administrative expense.

    Obamacare is the right direction.

  • Report this Comment On July 12, 2012, at 11:04 AM, orangefloyd wrote:

    Started to read the thread, don't have time for the whole thing, so I'll just cherry pick the comments near the beginning that I want to respond to:

    @famiglia112: Every day is a good day for healthy Americans. And no one is healthy every day.

    @Acesnyper: Good luck finding a country you'd like to move to that doesn't have socialized medicine.

    @Plinkon: Precisely. This is the way insurance works, no matter what kind of insurance it is. You pay whether you need it now or not, and it covers you when you do need it. Some people will pay in more than the benefits they extract, some people will pay less, in a perfectly efficient system, that will balance out with enough left over to pay the people who provide the service an acceptable amount. It's worth it because, for all of the talk about people who abuse their bodies (and the nonsensical assumption that they aren't already part of the insurance/healthcare system), there's really no way to predict who will hit the healthcare "jackpot" and need to be covered more than their contribution.

    For all of the people complaining about the mandate, I highly doubt most of them are in the 49 million who are currently without insurance, they're already paying exactly into the system they're complaining about, they just fear that their costs will go up as it expands, but they don't have a logical argument against it so they put up the strawman assuming the worst case of two people who each don't have insurance, one who is healthy and one who is unhealthy... the unhealthy person is now covered and getting back more than they contribute, the healthy person has a chunk of money taken from them for no benefit. This is a false scenario, not least because it ignores the fact that as we get older, we all need more and more from healthcare, no matter how healthy we are.

  • Report this Comment On July 15, 2012, at 9:19 AM, michaelmar wrote:

    Why not simply give vouchers to low income people to purchase basic health insurance. The govt has an abysmal record in the insurance business, as politicians always underestimate the costs and overestimate the benefits. The govt programs have waste and fraud of over 20%, while private insurers it is less than 2% (more than offsetting the higher admin costs of insurers). And the ACA increases govt programs substantially which will lead to even more waste and fraud, counted now in the tens and possibly hundreds of billions. The tiered voucher amount could be determined by income and reconciled on the tax return, and the insurers would compete for the business with various designed standardized plans, with riders for additional coverages if desired. A national special risk pool can be created to cover those with significant pre-existing conditions, subsidized by the govt and a small tax on all regular policies.

    On the other side, medical providers would no longer need to treat patients that do not have the ability to pay either through a policy or cash. It may seem cruel but the incentive to obtain at least minimal insurance with a free voucher must be greater than the penalty of not doing so. The costs associated with free care would partially pay for the vouchers, with additional savings from early intervention and treatment and the large pool of new insureds.

    And no mention is made in the article or by any govt official about how the ACA deals with the illegal immigrant population (12-20 million of the 50 million uninsured figure used), which no other country has to consider in their heath care system as we do. I don't think people can go to Canada from another country, walk into an emergency room and have a baby for free- and have that baby become a citizen of Canada. Will they purchase the mandated insurance, or file income taxes and pay the penalty, or continue to use emergency room health care, etc, etc?

  • Report this Comment On July 27, 2012, at 5:18 AM, thidmark wrote:

    "You are already paying for other peoples accidents and bad habits. Your car insurance is based on a risk pool of drivers, some bad drivers and some good drivers."

    I don't, however, pay for their "oil changes" and "tires," etc. ...

  • Report this Comment On August 07, 2012, at 11:17 PM, Shaw211 wrote:

    Firsk wrote,

    "... our own government systems- VA and Medicare- operate far more efficiently than the private insurance market does."

    I'd like to see the source for that. Given your ideology, I'd imagine it's from the government or a left-leaning think tank.

    Also, the catastrophic health insurance monthly rates quoted for you and your wife are fully 3X the amount I received two months ago for a 47-year old non-smoker. The deductible was $10,000 not $7,000 but that would only make a small difference.

  • Report this Comment On November 18, 2012, at 12:22 PM, Rhonda777 wrote:

    How are you suppose to pay for insurance when you have no income, unemployment ends. Husband disabled.

  • Report this Comment On March 26, 2014, at 1:26 AM, alliewinters wrote:

    with a heart filled with joy and testimonies i want to say a very big thanks to the great Dr. Charles, my life, my dream, my hope and my future was at the edge of falling apart i got married to my lovely and caring husband 8 years back and we were living happily as couples, we do have sex two times a week sometimes three time but i never conceived, then my heart was burdened and filled with worries so my husband suggest we visit a specialist in the clinic to know the actual problem why i could not get pregnant, when we got there after much test was carried out the doctor said that my husband have a low sperm count and i also have a Fibroid problem that we both can't have our own kids, when we got home from the clinic my husband was so sad about the result and very heart broken about the result at the clinic, so i told a friend the kind of problem i was facing so she said i should not worry about it, that she will help get through my problems and she gave me DR. CHARLES contact drcharlesbabyhome@gmail.com and i contacted him immediately, he told me that i should not worry that he is going to help me and i believed in him so much because my friend has told me much about him that he was the one who help her to bring back her husband when her husband abandoned her and the kids. so DR, CHARLES gave me some instruction and other things i should do and i obeyed him very well, to cut the story short at the end of the month i went for check up in the clinic and the doctor confirm that i am two weeks pregnant, i and my husband were very happy and grateful to DR. CHARLES for his help towards our family and today i am a happy mother of three kids two boys and a baby girl all thanks goes to the great DR. CHARLES Contact him today with his email: drcharlesbabyhome@gmail.com i am 100% sure that he will meet your heart desire.

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