I'm literally sick with worry about what we're facing next week.
So what do I do? I read and read and read, hoping to find someone with something interesting or enlightening to say.
No one is better informed than Princeton health care economist Uwe Reinhardt, and his latest column in the New York Times strikes me as a reasonable outcome.
These are, generally speaking, the options before the Court
The core question before the court is whether the Commerce Clause in Article 1, Section 8, Clause 3 of the Constitution grants the federal government the authority to mandate individual Americans to purchase specified, minimally adequate health insurance coverage from private health insurers.
. . .I recently posted a commentary on the options before the Supreme Court. Expanding upon that post a bit, I would describe the options before the Court thusly:
1. The Affordable Care Act is upheld as constitutional in all of its provisions.
2. Only the individual mandate is struck down, and it is deemed severable from the rest of the act.
3. Title 1 (Insurance Reform) of the act is struck down, but the rest of the act is upheld.
4. Both Titles 1 and 2 (Public Programs, including the expansion of Medicaid) are struck down, but the rest of the act is upheld.
5. The entire Affordable Care Act is struck down, on the grounds that the clause covering the individual mandate, deemed by the justices to be not authorized by the Commerce Clause, is deemed not severable from the rest of the bill.
Reinhardt thinks Option Two is most likely.
If I had to bet, I would put my marker on the second option, the striking down of the individual mandate only. The majority of the justices may sincerely believe that the Commerce Clause does not authorize the mandate. In addition, some may not be averse to giving the president a little slap in the face. In any event, striking the mandate would not do much damage to the rest of the bill.
Best explanation on the penalty piece of the mandate came from Lawrence O'Donnell on the Last Word.
Let's hope that the mandate gets chopped. As Reinhardt says, does the federal government [have] the authority to mandate individual Americans to purchase specified, minimally adequate health insurance coverage from private health insurers?
Imagine the for-profit insurance industry being required to sell everyone insurance regardless of their health. Imagine such a world.
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I'll leave you with yet another horrifying look at our broken healthcare system Getting Lost in the Labyrinth of Medical Bills, also from today's New York Times.
Like most patients and their families, the ailing man’s wife — who didn’t want to be identified because of concern her husband’s care could be compromised — simply wanted to figure out how much she really owed. That simple question has no simple answer, as an increasing number of consumers are finding out now that they are shouldering a greater share of their health care costs — whether they have a high-deductible plan, coinsurance or because they’re underinsured (or not insured at all). How did the hospital or doctor arrive at these charges? Are the charges reasonable? And are the charges for services actually rendered?
Hospital care tends to be the most confounding, and experts say the charges you see on your bill are usually completely unrelated to the cost of providing the services (at hospitals, these list prices are called the “charge master file”). “The charges have no rhyme or reason at all,” Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. “Why is 30 minutes in the operating room $2,000 and not $1,500? There is absolutely no basis for setting that charge. It is not based upon the cost, and it’s not based upon the market forces, other than the whim of the C.F.O. of the hospital.”
A grotesque tale Americans know all too well--of overcharges, price gouging, collection agencies and financial ruin, all in the name of for-profit healthcare, where our sickness is someone's profit.